Osteoporosis in rheumatoid arthritis.

Periarticular osteopenia of appendicular bones occurs early in the course of RA. Loss of the balance between bone resorption and formation contributes to the development of periarticular osteopenia and might be mediated through increased production of cytokines and prostaglandins by the synovium and bone marrow. Generalized osteopenia is also common and leads to an increased risk of fracture. Although the pathogenesis of this osteopenia is considered to be multifactorial, disease activity, immobility, corticosteroids and menopausal status are the important determinants.