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The osteoporosis is frequently observed in the patients with the inflammatory arthritis and painful rheumatism. The treatment of the osteoporosis for them is different from that for the patients without the arthritis or rheumatism. The recently developed biologic agents blocking tumor necrosis factor, interleukin(IL)-1, IL-6, or receptor activator of nuclear factor-kappaB ligand (RANKL) which are designed to treat the inflammatory arthritis are also expected to heal the osteoporosis in the inflammatory arthritis. The early use of the bisphosphonate is useful to prevent the glucocorticoid induced bone loss and to treat the spondyloarthropathy including the SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome. The clacitonin is useful for the painful rheumatism and osteoporotic fracture. The estrogen replacement is disputed because the stroke is known to occur more commonly in chronic inflammatory rheumatism than in general population. Moreover the pathogenesis of the most rheumatism may be partly related to the hormone. The parathyroid hormone therapy needs caution in the patients with calcium deposition disease and the hyperuricemia. We are reviewing the recent trend and development in the management of the primary, secondary and inflammatory osteoporosis in the patients with arthritis.
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