If you have rheumatoid arthritis and would like to participate in developing treatment guidelines, we would love your help. More information and the application can be found here.

When someone is diagnosed with osteoporosis, there is often a tendency to take more calcium. Getting enough calcium is important, but more isn’t necessarily better! The recommendation for people with low bone density is to aim for a total of 1200mg of calcium a day. It is ideal to get 1200mg of calcium from the diet (see here for the amount in certain foods) and only take calcium supplements if you need more. For example, the average American gets about 800mg of calcium a day from their diet. So taking 400mg of calcium supplements would be perfect.

(Patients with kidney disease, hyperparathyroidism, kidney stones, or other conditions that affect calcium should talk to their provider about how much calcium is right for them.)

Both weight-bearing and muscle-strengthening exercises are recommended for patients with osteopenia and osteoporosis. While muscle strength and balance training are important to reduce the risk of falling down, higher intensity loading may be necessary to stimulate bone formation and improve bone density. Studies from an Australian group with a specific training program (HiRIT) have reported a benefit in bone density in women and men. This program includes deadlift, squat, overhead press, jump drop, and balance exercises.


A recent study compared 8 months of HiRIT with a low-intensity program (similar to Pilates) in women with osteopenia or osteoporosis. It included a small number of women who were on osteoporosis medications to see if the combination of exercise and medications would be more helpful. The group who did HiRIT had a better spine bone density (about 2.5%), but neither exercise program helped with hip or forearm bone density. Unfortunately, only women on medications showed improvements in hip bone density, and doing HiRIT didn’t add anything to benefit of the medications for spine bone density.


In conclusion, women with low bone density who do not necessarily need to be on an osteoporosis medication may see some improvement in spine bone density with this high-intensity exercise program. Whether this improvement would lead to a lower risk of fracture isn’t clear, but it did lead to improved muscle strength and physical function, which is certainly important. Exercise continues to be an essential part of the prevention and treatment of low bone density, but this and other studies have shown it can only do so much for someone with osteoporosis who is at high risk for a fracture.

The FDA released a warning statement on 9/1/21 about a class of medications called JAK inhibitors, including Xeljanz, Olumiant, and Rinvoq. This was based on the results of a recent study involving people over the age of 50 who had at least 1 risk factor for heart disease (such as smoking, high blood pressure, or high cholesterol). It showed a higher risk of serious heart-related events, cancer, blood clots, and death compared to patients who were on other types of medications. The full results of this study haven’t been published yet, and we have requested this information, but it would be worth discussing this new warning with your Rheumatologist. If you are interested, please call to schedule an appointment.