Osteoporosis in Scleroderma

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Bone Density
Osteoporosis and Scleroderma
Media Stories
Patient Stories


Osteoporosis is when the bone density is low causing the bones to become porous and prone to fractures. In scleroderma, bone density can decrease due to certain medications, a decrease in exercise, change in diet and factors of the disease itself. It is important to discuss this with your doctor, especially if you have a history of osteoporosis in your family. ISN.

Osteoporosis occurs when the rate of bone resorption exceeds the rate of bone formation creating "porous bones." Most cases of osteoporosis occur as an acceleration of this normal aging process. The condition can also be caused by other disease processes or prolonged use of certain medications that result in bone loss. (Also see Bone Resorption)

Prevalence and risk factors for osteoporosis in individuals with chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis. Osteoporosis is prevalent in individuals with COPD and the prevalence appears to be high and similar in many countries. PubMed, Chest, 07/25/2019.

A System to Determine Risk of Osteoporosis in Patients With Autoimmune Hepatitis. Almost 20% of patients with AIH older than 50 years have osteoporosis. PubMed, Clin Gastroenterol Hepatol, 06/01/2019. (Also see Liver and Spleen Involvement)

Management of bone health in patients with celiac disease (CD): Practical guide for clinicians. Patients with CD require adequate calcium and vitamin D supplementation, as well as monitoring of vitamin D levels and bone mineral density with regular follow–up to help prevent osteoporosis and fractures. PubMed, Can Fam Physician, 2018 Jun;64(6):433-438. (Also see Celiac Disease)

Current status of the influence of osteoporosis on periodontology and implant dentistry. The impact of osteoporosis on the periodontal and peri–implant tissues was reviewed to emphasize the importance of oral hygiene measures, and the combined medical/dental assessment when osteoporotic patients are in need of dentoalveolar surgical procedures. PubMed, Curr Opin Endocrinol Diabetes Obes, 2016 Dec;23(6):435-439. (Also see Dental Implants)

The incidence and risk of osteoporosis in patients with anxiety disorder (AD): A Population–based retrospective cohort study. The risk ratios are the highest for osteoporosis within 1 year of AD diagnosis, but the risk remains statistically significant for »1 year and clinicians should pay particular attention to osteoporotic comorbidities in AD patients. PubMed, Medicine (Baltimore), 2016 Sep;95(38):e4912. (Also see Anxiety and Attitude)

Bone Density

Bone Density or Bone Mineral Density (BMD) is a measurement of the compactness of the bone or the amount of bone mass per square centimeter. Bone density measurements are used to diagnosis osteopenia, osteoporosis and fracture risk. ISN.

The associations of TNF-α gene polymorphisms with bone mineral density and risk of osteoporosis: A meta-analysis. The present meta-analysis demonstrated that TNF-α G308A polymorphism may act as a potential candidate biomarker for screening, diagnosis, and treatment of osteoporosis. PubMed, Int J Rheum Dis, 07/04/2019.

Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. PubMed, Osteoporos Int, 2019 Jun;30(6):1215-1222. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Factors associated with receiving bone mineral density (BMD) screening among people with multiple sclerosis (MS). Factors known to be associated with low BMD were associated with BMD screening in people with MS, but a clinically meaningful proportion of individuals with MS who have low bone mass may be missed. PubMed, Mult Scler Relat Disord, 2019 Jan 8;28:305-308. (Also see Multiple Sclerosis)

Hormone therapy and osteoporosis in breast cancer survivors: assessment of risk and adherence to screening recommendations. The natural, age–related reduction in bone density is exacerbated by breast cancer active aromatase inhibitors treatment. PubMed, Osteoporos Int, 11/09/2018. (Also see Cancer)

When to Get Your Bone Density Tested. Updated guidelines can help women decide when to have bone density screening but may discourage men. New York Times, 07/16/2018.

Anxiety tied to fracture risk in postmenopausal women. Older women with higher levels of anxiety than their peers are also more likely to develop poor bone health that increases the risk of fractures, a small study suggests. Reuters Health, 06/13/2018. (Also see Anxiety and Attitude)

Combination therapy of anabolic agents and bisphosphonates on bone mineral density (BMD) in patients with osteoporosis: a meta–analysis of randomised controlled trials. Compared with anabolic monotherapy, the concomitant combination therapy of anabolic agents and bisphosphonates significantly improved the BMD at the total hip and femoral neck. PubMed, BMJ Open, 2018 Mar 1;8(3):e015187.

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus (BO): a population–based nested case–control study. The incidence of osteoporotic fractures was not increased in BO patients compared to the general population and proton pump inhibitors use was not associated with increased fracture risk. PubMed, Aliment Pharmacol Ther, 10/05/2017. (Also see Esophageal (Throat) Involvement)

The Skeletal Effects of Inhaled Glucocorticoids. While the evidence is not conclusive, it supports using the lowest possible dose of inhaled glucocorticoids to treat patients with asthma and COPD and highlights the need for further research on this topic. PubMed, Curr Osteoporos Rep, 2016 Jun;14(3):106-13. (Also see Asthma Treatments)

Bone mineral density (BMD) is decreased in fibromyalgia syndrome (FMS): a systematic review and meta–analysis. In this meta–analysis, we observe that BMD at lumbar spine is decreased in FMS compared with normal individuals. PubMed, Rheumatol Int, 12/05/2016. (Also see Fibromyalgia)

Proton pump inhibitors use and change in bone mineral density. The results of this study showed that PPI use in subjects without risk factors of osteoporosis determined by the femoral T–score compared with the control group was associated with increased risk of developing osteoporosis and osteopenia in the femur bones. Wiley Online Library, 05/31/2016.

Osteoporosis and Scleroderma

Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features. The results of this study demonstrated that sarcopenia correlates with different nutritional, clinical, and biochemical parameters associated with the worsening of SSc. PubMed, Rheumatol Int, 08/01/2019. (Also see Myopathy and Myositis)

Distal radius and tibia bone microarchitecture impairment in female patients with diffuse systemic sclerosis (dSSc). Bone microarchitecture in patients with dSSc showed impairment of trabecular and cortical bone at distal radius and tibia and variables associated with hand involvement and disease duration may be considered prognostic factors of this bone impairment. PubMed, Osteoporos Int, 04/27/2019.

Trabecular Bone Score (TBS) Reflects Trabecular Microarchitecture Deterioration and Fragility Fracture in Female Adult Patients Receiving Glucocorticoid Therapy: A Pre–Post Controlled Study. These findings suggested that TBS and fracture risk assessment tool adjusted with TBS (T-FRAX) could be used as an adjunct in the evaluation of risk of fragility fractures in patients receiving glucocorticoid therapy. PubMed, Biomed Res Int, 2017;2017:4210217. (Also see Osteoporosis and Glucocorticoids, Steroids (Prednisone)

Bone mineral density (BMD) in patients with scleroderma systematica Low BMI, diffuse scleroderma, disease duration and glucocorticosteroids use are risk factors for reduced BMD and osteoporosis. PubMed,Ter Arkh, 2016;88(5):37-42. (Also see Steroid Warnings for Scleroderma)

Treatments for Osteoporosis

Osteoporosis Treatments and Care. Osteoporosis treatments come in several forms. Many should be started during childhood; others include prescription drugs to treat osteoporosis. Get an overview. WebMD.

Current and Emerging Strategies in Osteoporosis Management. Preventive and treatment strategies have to consider combination of non–pharmacological and pharmacological approaches for minimization of the fracture risk in osteoporosis. PubMed, Curr Pharm Des, 2017;23(41):6279-6287.

Trends and Determinants of Osteoporosis (OP) Treatment and Screening in Patients with Rheumatoid Arthritis (RA) Compared to Osteoarthritis (OA). OP care in RA patients was not better than OA patients, and the relative risk of application of this care has been decreasing in RA and OA patients. PubMed, Arthritis Care Res (Hoboken), 08/03/2017. (Also see Symptoms and Complications of Rheumatoid Arthritis)

Eighteen Months of Treatment With Subcutaneous Abaloparatide (ABL-SC) Followed by 6 Months of Treatment With Alendronate in Postmenopausal Women With Osteoporosis. Use of ABL-SC for 18 months followed by ALN for 6 months improved bone mineral density and reduced fracture risk throughout the skeleton and may be an effective treatment option for postmenopausal women with osteoporosis. PubMed, Mayo Clin Proc, 2017 Feb;92(2):200-210.

Treatment needs and current options for postmenopausal osteoporosis. The more recent advances in bone biology identified new targets for the development of drugs with a more potent and selective activity on either osteoclasts or osteoblasts. PubMed, Expert Opin Pharmacother, 04/07/2016.

Media Stories

Osteoporosis drugs may make bones weaker. Drugs used to treat weak bones in elderly patients suffering from osteoporosis may actually make them weaker, research suggests. BBC News, 03/01/2017.

Patient Stories

Edith: MCTD with En Coup de Sabre/Parry Romberg's, Lichen Sclerosus, Rheumatoid Arthritis, Sjogren's My GP is fabulous, but at the end of the day it is not enough. I would be lost without people like you…

Susie: CREST Syndrome I have had CREST syndrome for the past eight years. My specialist is Dr. Frederick Wigley, from Johns Hopkins…

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