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Vitamin D in Rheumatic Disease - is it Good Enough?

Jack Cush, MD

Vitamin D deficiency or insufficiency of is highly prevalent and has been often associated with inflammatory rheumatic diseases, raising the question of whether inadequate vitamin D status contributes to immune dysregulation, incipient disease, increased disease activity, or poor skeletal outco

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Prescribing Lessons (4.17.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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RA erosions bone ACR

b/ts-DMARDs Do Not Arrest Bone Loss in RA

Jack Cush, MD

In RA, the goal is to control or arrest inflammation such that articular and bony damage is halted. While we have many effective therapies, it is not clear that biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) can prevent or improve osteoporosis outcomes in RA. A current real-world study showed that 1 year of b/tsDMARDs use did not arrest osteoporosis progression.

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Osteoporosis: Thinking outside the box

Robert Chao, MD

As rheumatologists, most of us manage osteoporosis in some form every single day. We have newer agents, newer sequencing strategies, and an increasing number of patients asking for “less medicinal” options that go beyond a prescription. At RWCS, Dr. Gina Woods opened her talk by reframing osteoporosis as a comprehensive approach to bone and muscle health rather than a narrow discussion about a DEXA report.

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3 Months of Romosozumab in Postmenopausal Osteoporosis

Jack Cush, MD

A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course.

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A Modern Approach to Osteoporosis Management

Adela Castro, MD

Currently, fewer than half of patients diagnosed with osteoporosis receive appropriate pharmacologic therapy. This treatment gap reflects several challenges in osteoporosis management, including limited disease awareness, barriers to medication access, clinician discomfort with therapy selection, and uncertainty regarding the optimal timing of treatment initiation.

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FDA has approved a dosing update for burosumab-twza (Crysvita, Kyowa Kirin) to allow for increased dose and frequency when needed in adults with X-linked hypophosphatemia (XLH). https://t.co/EPyp6tDsaf https://t.co/1HEaQRk9BR

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Dr. John Cush RheumNow ( View Tweet)
Vitamin D in Rheumatic Disease - Is It Good Enough? Vitamin D in rheumatic disease — is it sufficient? Vitamin D deficiency/insufficiency is common and linked to inflammatory rheumatic diseases, raising the question of whether low vitamin D drives immune dysregulation, disease https://t.co/CLBFii2TbR
Dr. John Cush RheumNow ( View Tweet)
Femoral BMD & osteoporosis are independent predictors (nverse relationship) of all-cause mortality in postmenopausal women. NHANES study(2005-2018) of 2,977 postmenopausal F, OP yielded 47% incr mortality (HR 1.47) https://t.co/67Jv63X0Hx https://t.co/4vbFDydTY7

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Dr. John Cush RheumNow ( View Tweet)
True or False: In a meta-analysis, RA was associated with a significantly increased risk of osteoporotic fractures in female patients but not in male patients. See if you got it right in the latest RheumIQ quiz at https://t.co/HCxOwRl2Tq. https://t.co/O9WRKQKmu4

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Dr. John Cush RheumNow ( View Tweet)
Presented at AACE Annual Meeting, FREEDOM Real-World Study looked atypical femoral Fxs & found a low AFF risk - 24 AFFs w/ denosumab (0.89/1KPY) vs 397 AFFs w/ bisphosphonates (0.82/1KPY) but no active comparators & excluded pts w/ comorbidities. https://t.co/vRwkfHSXxh https://t.co/xzgC0D5ZTu

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Dr. John Cush RheumNow ( View Tweet)
Cross-sectional study from UK Clinical Practice Research Datalink Aurum looked at > 40K w/ #PMR Rx w/ steroids - 67% were coprescribed bisphosphonates (BP) & 79% Rx PPIs/H2RAs (less in males & pts deprived areas) resulting more Fx w/in 12 mos (2.32% vs 1.4%). https://t.co/b2DFJMjqCu
Dr. John Cush RheumNow ( View Tweet)
Predictors of Calcinosis Cutis in Systemic Sclerosis Calcinosis cutis (CaC) is a common and disabling non-lethal manifestation in systemic sclerosis (SSc). This study used SSc patients from the EUSTAR database to clinically characterize patients and identify risk factors for https://t.co/uXbcCa04Lv
Dr. John Cush RheumNow ( View Tweet)
Portugese multicentre retrospective of 748 adults with JIA (age 28 yrs; Dz duration 21 yrs). Oligoarticular JIA was the most common subtype (29.9%). HTN (9%), psychiatric dz (8%), & osteoporosis (5%) were most prevalent comorbidities. bDMARD use reduced risk of psych Dz https://t.co/xCrTDxirlj
Dr. John Cush RheumNow ( View Tweet)
#Glucocorticoid-induced #osteoporosis results from direct suppression of osteoblast & osteocyte function, a transient stimulation of osteoclast formation & activity, catabolic effects on #bone matrix & muscle protein, and metabolic alterations https://t.co/ZmMFAOJkmw #OpenAccess https://t.co/6CubKRbjin

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The Lancet Diabetes & Endocrinology TheLancetEndo ( View Tweet)
3 Months of Romosozumab in Postmenopausal Osteoporosis A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/HPM7DdRFBM
Dr. John Cush RheumNow ( View Tweet)
3 Months of Romosozumab in Postmenopausal Osteoporosis A report in The Lancet Diabetes & Endocrinology suggested that 3 months of romosozumab (ROMO) followed by denosumab is as effective at increasing hip bone mineral density (BMD) as the standard 12-month course. https://t.co/6HfGFZqavF
Dr. John Cush RheumNow ( View Tweet)
New studies posted this week in Arthritis & Rheumatology: Adalimumab ± MTX as first-line therapy for childhood-onset chronic uveitis https://t.co/L4QiZZBBG7 Bisphosphonates & PPI/H2RA coprescriptions in polymyalgia rheumatica https://t.co/62Pqt5Ab58 Phase 3b SOLSTICE trial: https://t.co/MsK4XC3eNh

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American College of Rheumatology ACRheum ( View Tweet)
RT @richardPAconway Updated data on RA-ILD from Olmstead County. Cumulative incidence of 15.3% over 20 years! #RNL26 https://t.co/wVrTc3QM6Y
Dr. John Cush RheumNow ( View Tweet)
TOPKAT Trial: Partial vs Total Knee Replacement Patients with osteoarthritis (OA) primarily affecting only one knee joint compartment did just as well with partial knee replacement (PKR) as with total arthroplasty after 10 years in a randomized trial -- and maybe a little bit https://t.co/MNpVeHQbJ2
Dr. John Cush RheumNow ( View Tweet)
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