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Obesity potentially protects against systemic bone loss in patients with rheumatoid arthritis treated with tumour
Seung Yun Lee1, Kyong-Hee Jung1, Shin-Goo Park2
1Division of Rheumatology, College of Medicine, Inha University, Incheon, Republic of Korea.
Objectives:
We aimed to investigate how systemic bone metabolism was affected after 1 year of treatment with tumour necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) patients.
Methods:
A total of 29 seropositive RA patients not treated for osteoporosis were enrolled and TNF inhibitors were administered for a year. Bone mineral density (BMD) at the lumbar spine, femur neck, and total hip was measured at baseline and 12 months after anti-TNF treatment. Blood samples were collected at baseline and 6 and 12 months after anti-TNF treatment and osteoclasts were cultured on bone slices. Weight was the strongest factor influencing systemic bone loss. Patients were categorised into two groups: obese (body mass index (BMI) ≥25 kg/m2) and non-obese (BMI <25 kg/m2).
Results:
All patients showed decreased BMD at all sites. The obese group showed relatively little change in BMD, although the non-obese group showed significant decreases in BMD at all sites after 1 year of treatment with TNF inhibitors. Resorption pits created by osteoclasts decreased at 6 months and increased at 12 months in the non-obese group, while the obese group presented with steadily decreasing sizes of resorption pits at all-time points. Levels of receptor activator of nuclear factor kappa B ligand were significantly decreased at 12 months compared to baseline in the obese group, while they were increased in the non-obese group.
Conclusions:
One year of treatment with TNF inhibitors failed to halt systemic bone loss in RA patients, but obesity may have protective effects against bone loss.
Insights
Tumour necrosis factor (TNF) inhibitors did not prevent bone loss in rheumatoid arthritis (RA) patients after one year. However, obesity appeared to offer a protective effect against systemic bone loss in these patients.
Area of Science:
- Rheumatology
- Bone Metabolism
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is associated with systemic bone loss.
- Tumour necrosis factor (TNF) inhibitors are a common treatment for RA.
- The effect of TNF inhibitors on bone metabolism in RA patients is not fully understood.
Purpose of the Study:
- To investigate the impact of one year of TNF inhibitor treatment on systemic bone metabolism in RA patients.
- To explore the role of obesity in modulating bone loss during TNF inhibitor therapy.
Main Methods:
- 29 RA patients received TNF inhibitors for 12 months.
- Bone mineral density (BMD) was measured at baseline and 12 months.
- Osteoclast activity and serum markers were assessed.
- Patients were categorized as obese (BMI ≥25 kg/m²) or non-obese (BMI <25 kg/m²).
Main Results:
- All patients experienced decreased BMD.
- Non-obese patients showed significant BMD decreases at all sites.
- Obese patients exhibited less BMD reduction and decreased osteoclast activity.
- Receptor activator of nuclear factor kappa B ligand levels decreased in obese patients and increased in non-obese patients.
Conclusions:
- One year of TNF inhibitors did not halt systemic bone loss in RA patients.
- Obesity may confer a protective effect against bone loss in RA patients undergoing TNF inhibitor therapy.
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