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Rev Bras Reumatol. 2015 May-Jun;55(3):256-63. doi: 10.1016/j.rbr.2014.10.007. Epub 2014 Nov 25.

[Osteoporosis in Rheumatoid Arthritis: role of the vitamin D/parathyroid hormone system].

[Article in Portuguese]

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Unidade de Clínica Médica e Reumatologia, AOU Maggiore della Carità, Novara, Itália. Electronic address:
Unidade de Clínica Médica e Reumatologia, AOU Maggiore della Carità, Novara, Itália; Centro de Pesquisa Interdisciplinar de Doenças Autoimunes (Ircad), Departamento de Medicina Translacional, Università del Piemonte Orientale A. Avogadro, Novara, Itália.


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 multiple homeostatic 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-regulatory roles, 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.


Artrite reumatoide; Cholecalciferol; Colecalciferol; Hormônio paratireóideo; Osteoporose; Osteoporosis; Parathyroid hormone; Rheumatoid Arthritis

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