Osteoporosis is a well-established extra-articular feature of Rheumatoid Arthritis (RA).Systemic inflammation seems to play a crucial role in causing an alteration of multiplehomeostatic systems implied in bone health, such as the RANK/RANKL/Osteoprotegerin and Wnt/β catenin pathways; several other causal factors have been called into question, including the chronic use of corticosteroids. Since vitamin D exerts important immune-regulatoryroles, it has been claimed that derangement of the vitamin D/parathyroid hormone (PTH) system, a well-known determinant of bone health, may play a pathogenic role in autoimmunity; animal models and clinical data support this hypothesis. Furthermore, RA patients seem to be relatively refractory to vitamin D-induced PTH suppression. Therefore, the link between RA and osteoporosis might in part be due to alterations in the vitamin D/PTH system. A better understanding of the pathophysiology of this system may be crucial to prevent and cure osteoporosis in patients with inflammatory/autoimmune diseases. A major clinical correlate of the strict cooperation and interdependence between vitamin D and PTH is that correction of the vitamin D deficiency, at least in autoimmune diseases, should be targeted to PTH suppression.
CITATION STYLE
Bellan, M., Pirisi, M., & Sainaghi, P. P. (2015). Osteoporosis in Rheumatoid Arthritis: Role of the vitamin D/parathyroidhormone system. Revista Brasileira de Reumatologia. Elsevier Editora Ltda. https://doi.org/10.1016/j.rbr.2014.10.007
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