Ask the doctor: "I have rheumatoid arthritis and at risk of osteoporosis"

Rheumatoid arthritis and the risk of osteoporosis

Dr Sarah Jarvis MBE, medical writer and broadcaster and BBC The One Show and Radio 2's doctor, explains osteoporosis risk factors, how osteoporosis is diagnosed and the types of treatment available. 

Q. I have rheumatoid arthritis and my doctor says I'm at risk of osteoporosis, even though I'm only 52. Do I need a bone scan?

A. Osteoporosis, a condition that weakens bones, is often called the 'silent epidemic'. More than one in three women and one in five men with break a bone because of osteoporosis.

As a woman, your risk rises significantly after the menopause. National guidelines recommend all women should have an assessment of their risk of osteoporosis once they reach 65 (for men it's over 75). But they also recommend assessing your risk if you're over 50 and have any other risk factor for osteoporosis-related fracture. This includes

• a history of falls;
• being underweight; smoking or drinking more than 14 units of alcohol per week;
• diabetes;
• Cushing's disease, overactive thyroid or parathyroid gland;
• bowel conditions such as Crohn's disease, ulcerative colitis or coeliac disease, which may reduce your ability to absorb nutrients from your diet;
• and chronic liver, kidney or lung disease.

Rheumatoid arthritis and psoriatic arthritis are also risk factors.

If you're using oral steroids or have used them in the past, you should be assessed once you reach 50. If you've taken regular high-dose oral steroids (7.5mg prednisolone daily for three months or more), you should be assessed, even if you're under 40.

The gold standard for assessing bone density is called a DEXA scan, available on the NHS. Based on the results, your doctor may recommend medication called biphosphonate - either regular tablets or an infusion through a vein once a year. 

In more severe cases, medicines called osteoanabolics are recommended to actively build your bones up. Calcium and vitamin D, as well as weight-bearing exercise, are also important.

Anyone concerned about their risk of osteoporosis can complete the quick and risk checker from the Royal Osteoporosis Society at theros.org.uk.