Relationship between osteoporosis and arthritis and effect of corticosteroids and other drugs on bone

Patients with inflammatory arthritides such as rheumatoid arthritis develop both localized and generalized osteoporosis and have an increased risk of fracture. Bone loss can occur early and is directly related to the inflammatory process as well as to the indirect effects of arthritis on physical activity. Corticosteroid-induced osteoporosis remains a common and important problem in rheumatic disease, but controversy continues about the relative safety of "low-dose" corticosteroid therapy in regard to effects on bone, which should be weighted against the beneficial effects of controlling synovitis and minimizing functional impairment. Further studies are needed to evaluate therapies for glucocorticoid-induced osteoporosis, but prophylaxis or treatment with calcitriol, the active form of vitamin D, or the bisphosphonates shows considerable promise.