Rheumatoid Arthritis and Osteoporosis Risks

Those with rheumatoid arthritis who take corticosteroids, even at low doses, are at risk for osteoporosis, the thinning of our bones that can make them crumble or break. Steroids diminish your body’s ability to absorb calcium from the intestines and hamper the manufacture of new bone.

Osteoporosis primarily affects the bones of the hip, wrists, and spine. It results in about 1.3 million fractures a year, including spinal fractures in one-third of women older than 65. Preventive measures are particularly important because there are no early warning signs of osteoporosis: The first indications may be a decrease in height or the formation of a dowager's hump as bone in the spine collapses.

Your body borrows calcium daily from your bones for your blood to use. But it also redeposits calcium regularly from the food you eat, so new bone is continually being formed. Around age 40 to 44, the regrowth begins to slow down, and we begin to lose more bone than we manufacture. Add steroids to the mix, and the loss accelerates. To make matters worse, as we get older, it also gets harder for our bodies to absorb calcium--just when we tend to be eating less and in general taking in less calcium in our diets.

Extra vitamin D and calcium, however, can prevent or slow osteoporosis. Most women need 1,500 milligrams of calcium per day, and men need 1,000. The daily requirement for vitamin D is 400 international units (IU), but double that for people older than 50. (Based on blood tests, however, your doctor may recommend a higher dose.)

In a study on rheumatoid arthritis, people on corticosteroids who took supplements of 1,000 milligrams of calcium and 500 IU of vitamin D daily had an increase in bone mineral thickness in their lower spines. Those who didn’t get the supplements had a 3 percent bone loss each year. (The supplements had no effect on bone thickness in people who didn’t take corticosteroids.)

Nutritionists generally recommend trying to get your nutrients through food rather than supplements, however. This is both because you’re less likely to overdose on foods and because nutrients may work better when they’re in a “package deal” -- all wrapped up with other essential nutrients in healthy food. Here are good dietary ways to shore up your stores of calcium and its vital bone-building partner, vitamin D.

 Boning Up On Calcium

The best sources of calcium are milk and dairy products. You can choose low-fat or fat-free cheeses, yogurt, or milk. Other good sources are canned salmon and sardines (if you eat the soft bones as well), calcium-fortified orange or grapefruit juice, and broccoli. You can also find smaller amounts of calcium in leafy greens such as kale, collard greens, and turnip greens.

Each serving of cheese, yogurt, or other dairy products equals about 300 milligrams. So if you aim for five servings of calcium-rich foods per day, you'll be getting 1,500 milligrams. If you can’t take in that much in food alone, as many people find hard to do, consider a supplement. For best results in preventing osteoporosis the National Osteoporosis Foundation suggests a supplement of 1,000 to 1,500 milligrams of calcium for people 65 and older; women not taking estrogen need the higher amount.

Other ways to boost your calcium intake: Add nonfat dry milk to hot cereals, stews, casseroles, meat loaf, or mashed potatoes; use ricotta cheese or cottage cheese as a sandwich filling or spread on toast; replace beef or chicken in stir-fry recipes with tofu, or soybean curd; add tofu, or soybean curd, to salads; have low-fat milkshakes instead of soft drinks.

And while you’re upping your intake, you’ll also want to slow your calcium “out-take”,; or loss, in the following ways.

• Limit coffee. One study showed that middle-aged women who drank more than six cups of coffee a day had three times the risk of hip fracture than those who drank less than a cup and a half a day. Caffeine may harm your bones directly, or indirectly by making you urinate more often, which increases the amount of calcium you lose in your urine. It’s wise to cut your coffee intake or consider making the switch to decaf.
  
• Cut back on alcohol. Alcohol can interfere with your ability to absorb and use calcium. Because women's ovaries are sensitive to alcohol, it can alter the hormonal balance necessary for strong bones. And alcohol's diuretic qualities may also promote more calcium loss through the urine.
  
• Watch your soda intake. The amount of phosphorus in your diet may affect how much calcium you can obtain from your food. Some studies suggest that large amounts of sodas, which contain phosphoric acid, can limit the calcium you’ll have available. One survey found that women who drank carbonated drinks had more than twice as many broken bones as those who didn’t drink soda. It won’t hurt to limit your soda intake to one can a day or less.

 Don’t Forget “D” Sunshine Vitamin

Vitamin D is important in building bones and keeping them strong. Without enough D, bone and the cartilage that covers it may not recover fully after an injury or blow. Vitamin D is found in green leafy vegetables such as kale and collard greens and in egg yolks and enriched milk.

Your body can also manufacture vitamin D from exposure to sunlight. This is tricky, as you don’t want to risk sunburn or excessive sun exposure, but researchers estimate that 10 to 15 minutes of sunlight can provide enough sun to help your bones. (It’s best to spend this time outdoors in early morning or late afternoon, thus avoiding the hours when the sun’s damaging rays are strongest.) You can also get the recommended daily allowance of 400 IU from two glasses of enriched milk.

Last Updated: 8/26/2002
The Johns Hopkins University 1996-2003.  All rights reserved.  This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.