DESTIN, FLA. — Patients with rheumatic disease and osteoporosis or low-impact fracture might benefit from early sequential therapy with anabolic and antiresorptive drugs to build and maintain bone, Dr. Nancy Lane reported at a rheumatology meeting sponsored by Virginia Commonwealth University.
“Although the exact treatment recommendation is still unclear, you could use parathyroid hormone for a year or two to change the bone architecture in a positive way and then maintain those gains with an antiresorptive agent—either a bisphosphonate or a selective estrogen receptor modulator,” Dr. Lane said.
The continuous inflammation of diseases like systemic lupus erythematosus and rheumatoid arthritis appears to adversely affect bone health by increasing bone resorption and decreasing formation. Even premenopausal patients with relatively normal bone density are at high risk for skeletal problems, said Dr. Lane, director, the Center for Healthy Aging at the University of California, Davis.
In a study of vertebral fractures in 70 patients with systemic lupus erythematosus who were compared with 22 matched healthy controls, no bone mineral density differences were found between the two groups. However, 21% of the lupus group had at least one thoracic or lumbar spine fracture, compared with no subjects in the control group. The study included premenopausal women with a mean age of 31.5 years (Lupus 2005;14:529–33).
The first step is to address the problem of systemic inflammation, Dr. Lane said. But it's also critical to be aggressive in identifying and treating those who are at risk for fracture. Glucocorticoid therapy can also induce osteoporotic changes. Initiating therapy early is important, Dr Lane said at the meeting, also sponsored by the International Society for Clinical Densitometry and the Alabama Chapter of the Arthritis Foundation.