RHEUMATOID ARTHRITIS: Edited by Bryant R. EnglandOsteoporosis and fractures in rheumatoid arthritisWysham, Katherine D.a; Baker, Joshua F.b; Shoback, Dolores M.cAuthor Information aRheumatology Section, VA Puget Sound Healthcare System, Division of Rheumatology, University of Washington, Seattle, Washington bRheumatology and Epidemiology, Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania cEndocrine Research Unit, SFVAMC, UCSF, UCSF Training Program in Diabetes, Endocrinology and Metabolism, San Francisco, California, USA Correspondence to Katherine D. Wysham, MD, VA Puget Sound HCS Seattle Division: VA Puget Sound Healthcare System, 1660 South Columbian Way, S-151-A, Seattle, WA 98108, USA. Tel: +1 206 764 2251; e-mail: [email protected] Current Opinion in Rheumatology: May 2021 - Volume 33 - Issue 3 - p 270-276 doi: 10.1097/BOR.0000000000000789 Buy Metrics Abstract Purpose of review Rheumatoid arthritis (RA) is associated with increased risk for osteoporotic fracture. We highlight RA-specific risk factors for bone mineral density (BMD) loss and fractures and considerations regarding the diagnosis and treatment of osteoporosis in patients with RA. Recent findings Anticitrullinated protein antibody (ACPA) positivity, although associated with low BMD in early RA, is not associated with accelerated BMD loss over time when compared to ACPA negative individuals. Studies have found reduced BMD in individuals on low doses of glucocorticoids (GCs). Poor functional status and frailty are additional important risk factors for low BMD and fractures. Heightened fracture risk in RA may be mitigated by tight disease control, and biologic therapies are associated with more stable BMD compared to nonbiologic therapies. Evidence-based guidelines specific for treating osteoporosis in patients with RA do not exist. Thus, treatment decisions are based on general osteoporosis guidelines, taking into account additional RA-specific risk factors. Summary Recent studies have advanced knowledge of RA-specific risk factors for BMD loss and fractures. Future studies applying these findings to modify established fracture risk algorithms as well as evaluating osteoporosis treatments in RA cohorts are needed to reduce the risk of disabling fractures in these patients. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.