Osteoporosis in Women with Rheumatic Diseases

Objective. To summarize current data (through August 2025) on the epidemiology, risk factors, diagnosis, and treatment of osteoporosis in women with rheumatic diseases (RD), including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), axial spondyloarthritis/ankylosing spondylitis (axSpA/AS), and psoriatic arthritis (PsA). Methods. A targeted review was conducted with a description of the search methodology (PubMed/MEDLINE, PubMed Central, Web of Science), as well as an analysis of current clinical guidelines (ACR/EULAR, ISCD, IOF/BHOF). Systematic reviews/meta-analyses, large cohort studies, and randomized clinical trials on the diagnosis and treatment of postmenopausal osteoporosis and glucocorticoid-induced osteoporosis (GIOP) published in 2015–2025 were included, with priority given to 2023–2025. Results. In women with RA, the prevalence of osteoporosis reaches ~28% (95% CI 24–31%) according to meta-analysis data, which is higher than in the general population of similar age; in patients with SLE, the risk of osteoporotic fractures in population-based cohort studies is almost three times higher than in matched controls. For axSpA/AS, an increased burden of low bone mineral density (BMD) and predominantly vertebral fractures has been shown; in PsA, fracture risk also increases (including vertebral fractures). Modifiable risk factors include inflammation, immobilization, calcium/vitamin D insufficiency, smoking, and especially the use of systemic glucocorticoids (dose-dependent effect). The diagnostic gold standard is dual-energy X-ray absorptiometry (DXA) according to the ISCD 2023 positions; for risk stratification, FRAX/FRAXplus and adjustment with trabecular bone score (TBS) are recommended. Assessment of vertebral fractures (VFA/radiography) is mandatory in RD and glucocorticoid therapy. Bone turnover markers (P1NP, β-CTX) are useful for monitoring treatment response. Prevention and treatment include lifestyle modification; adequate calcium and vitamin D intake; and pharmacotherapy according to risk level. Bisphosphonates, denosumab, teriparatide/abaloparatide, and romosozumab have proven anti-fracture efficacy; for GIOP, the ACR 2023 recommendations are relevant, prioritizing anabolic therapy in very high-risk individuals and mandatory sequential antiresorptive therapy after discontinuation of denosumab/anabolics. Selective estrogen receptor modulators and menopausal hormone therapy are considered in specific clinical scenarios. Conclusions. In women with RD, osteoporosis occurs more often and manifests earlier due to the combination of chronic inflammation, estrogen deficiency (menopause), and the effects of glucocorticoids. Early risk identification (DXA + FRAX/FRAXplus + TBS), timely initiation of therapy, and multidisciplinary management (rheumatologist–endocrinologist–physician–rehabilitation specialist) reduce the fracture burden. Practical proposals for screening and treatment are presented, as well as unresolved issues and directions for future research.

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