Overview
Rheumatoid osteoperiostitis, also known as rheumatoid arthritis-associated osteoporosis, is a condition characterized by reduced bone density and increased fracture risk in individuals with rheumatoid arthritis. It is often exacerbated by the use of glucocorticoids.Diagnosis
Initial assessment of fracture risk should include clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old 1.Management
For adults at medium, high, or very high fracture risk, pharmacologic treatment is strongly recommended 1.
Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making 1.
Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk 1.Special Populations
Recommendations are made for special populations, including children and people with organ transplants 1.Key Recommendations
For adults beginning or continuing >3 months of GC treatment, as soon as possible after initiation of GCs, initial assessment of fracture risks with clinical fracture assessment, bone mineral density with vertebral fracture assessment or spinal x-ray, and Fracture Risk Assessment Tool if ≥40 years old is strongly recommended 1. (Evidence: Strong)
For adults at medium, high, or very high fracture risk, pharmacologic treatment is strongly recommended 1. (Evidence: Strong)
Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making 1. (Evidence: Strong)
Anabolic agents are conditionally recommended as initial therapy for those with high and very high fracture risk 1. (Evidence: Conditional)References
1 Humphrey MB, Russell L, Danila MI, Fink HA, Guyatt G, Cannon M et al.. 2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis & rheumatology (Hoboken, N.J.) 2023. link