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Bisphosphonates in inflammatory rheumatic diseases.

Pilar Peris1, Ana Monegal1, Núria Guañabens1

  • 1Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.

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|February 16, 2021
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Summary

Bisphosphonates (BPs) are known for treating osteoporosis. This review explores their potential immunomodulatory and anti-inflammatory effects, particularly in rheumatic diseases, suggesting a role beyond bone resorption.

Keywords:
Ankylosing spondylitisExperimental arthritisNitrogen-containing bisphosphonatesRheumatoid arthritisSAPHOSpondyloarthropathies

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Area of Science:

  • Pharmacology
  • Immunology
  • Rheumatology

Background:

  • Bisphosphonates (BPs) are primary treatments for osteoporosis due to their bone antiresorptive properties.
  • Emerging research suggests BPs may possess immunomodulatory and anti-inflammatory actions.
  • Their role in preventing structural joint damage in rheumatic diseases warrants further investigation.

Purpose of the Study:

  • To review the non-antiresorptive actions of bisphosphonates (BPs).
  • To explore the immunomodulatory and anti-inflammatory effects of BPs.
  • To assess the potential of BPs in managing structural joint damage in inflammatory rheumatic diseases.

Main Methods:

  • Literature review focusing on bisphosphonates (BPs).
  • Analysis of studies on BP mechanisms, including the mevalonate pathway and T-cell activation.
  • Examination of research on BP effects in inflammatory rheumatic diseases like rheumatoid arthritis and spondyloarthropathies.

Main Results:

  • Nitrogen-containing BPs (N-BPs) modulate the acute-phase response via pro-inflammatory cytokines and T-cell pathways.
  • BPs demonstrate anti-inflammatory capacity, potentially preventing structural joint damage in inflammatory conditions.
  • Differential immune responses in bone lesions of rheumatoid arthritis and spondyloarthropathies are influenced by BPs.

Conclusions:

  • Bisphosphonates (BPs) exhibit potential immunomodulatory and anti-inflammatory effects beyond their established antiresorptive action.
  • Further research is needed to fully understand the impact of BPs on inflammatory-mediated diseases.
  • BPs may serve as a valuable adjunctive therapy for preventing or treating structural damage in inflammatory rheumatic disorders.