Bone mineral density in rheumatoid arthritis patients on antirheumatic therapies: a systematic review

Area of Science:

• Rheumatology
• Orthopedics
• Pharmacology

Background:

• Rheumatoid Arthritis (RA) significantly increases fracture risk due to systemic bone loss.
• Disease-modifying antirheumatic drugs (DMARDs) improve RA control, but their effect on bone mineral density (BMD) is debated.
• Understanding DMARDs' impact on BMD is crucial for managing fracture risk in RA patients.

Purpose of the Study:

• To systematically review the effects of conventional synthetic (cs), biologic (b), and targeted synthetic (ts) DMARDs on BMD in RA patients.
• To analyze how factors like glucocorticosteroid use, antiosteoporotic therapy, and disease activity influence DMARD efficacy on BMD.
• To identify potential differences in BMD effects among specific csDMARD, bDMARD, and tsDMARD agents.

Main Methods:

• A systematic review of 13,340 records, with 46 studies meeting inclusion criteria.
• Studies were analyzed based on the type of DMARD used (csDMARD, bDMARD, tsDMARD).
• Concomitant use of glucocorticosteroids (GCS), antiosteoporotic therapy (AOT), and disease activity levels were considered in the analysis.

Main Results:

• Conventional synthetic DMARDs (csDMARDs) appear beneficial for BMD.
• Biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) show a greater positive effect on BMD compared to csDMARDs, based on the balance of evidence.
• Preliminary data suggests variations in BMD effects among different csDMARD, bDMARD, and tsDMARD agents, warranting further investigation.

Conclusions:

• csDMARDs demonstrate a positive impact on BMD in RA patients.
• bDMARDs and tsDMARDs generally exhibit a more pronounced positive effect on BMD than csDMARDs.
• Further research is needed to confirm superior effects of specific DMARDs and to elucidate their mechanisms of action on bone metabolism in RA.