Effects of anti-tumor necrosis factor α agents on bone

Area of Science:

• Rheumatology
• Immunology
• Bone Metabolism

Background:

• Tumor necrosis factor (TNF) inhibitors are established treatments for inflammatory diseases.
• While effective for disease control, their impact on bone health, specifically osteoporosis and fractures, requires further elucidation.

Purpose of the Study:

• To review the current evidence on the role of TNF inhibitors in preventing bone loss and fractures.
• To assess whether TNF inhibitors offer advantages over conventional therapies for bone health outcomes.

Main Methods:

• Review of existing studies examining TNF inhibitors' effects on bone turnover markers, bone mineral density (BMD), and fracture incidence.
• Analysis of study methodologies, including sample size and placebo control.

Main Results:

• Numerous studies assess TNF inhibitors' impact on bone turnover markers, but few evaluate BMD or fractures.
• Existing studies often have small sample sizes and limited placebo-controlled designs.
• Evidence suggests anti-TNF therapy's bone-protective effects are linked to disease activity control.

Conclusions:

• The bone-antiresorptive effects of TNF inhibitors are primarily attributed to their anti-inflammatory actions.
• Current research does not support TNF inhibitors as superior to nonbiologic therapies for preventing bone loss and fractures.