Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs Do Not Arrest Bone Loss in Patients With...

Area of Science:

• Rheumatology
• Endocrinology
• Bone Metabolism

Background:

• Rheumatoid arthritis (RA) significantly increases fracture risk, yet osteoporosis treatment rates are low.
• Biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are used to manage RA, with some evidence suggesting potential benefits for osteoporosis.
• Previous studies indicated that 1-year b/tsDMARDs use did not halt osteoporosis progression in RA patients.

Purpose of the Study:

• To investigate the longer-term effects of b/tsDMARDs on bone mineral density (BMD) in patients with active rheumatoid arthritis (RA).
• To determine if sustained control of RA disease activity with b/tsDMARDs influences BMD changes over time.
• To identify factors associated with BMD changes in RA patients undergoing b/tsDMARD therapy.

Main Methods:

• A real-world, observational study followed 797 RA patients treated with b/tsDMARDs for up to 5 years.
• Bone mineral density (BMD) T-scores were assessed as the primary endpoint, with changes in related factors as secondary endpoints.
• Patients were categorized based on concurrent anti-osteoporosis treatment (anti-osteoporosis (-) vs. anti-osteoporosis (+)).

Main Results:

• Despite significant improvement in Clinical Disease Activity Index (CDAI) scores, BMD (T-scores) decreased significantly in the femoral neck and radius for patients not receiving anti-osteoporosis treatment.
• BMD T-scores remained relatively stable in patients receiving concurrent anti-osteoporosis treatment.
• 58% of all patients experienced a decrease in T-score; baseline T-score and duration of osteoporosis treatment were associated with BMD changes, while b/tsDMARDs duration and mean CDAI were not.

Conclusions:

• Rheumatoid arthritis (RA) patients treated with b/tsDMARDs can still experience bone mineral density (BMD) loss, even with controlled disease activity.
• Osteoporosis should be considered an independent comorbidity in RA management, requiring specific interventions beyond inflammation control.
• Concurrent anti-osteoporosis treatment appears crucial for maintaining BMD in RA patients on b/tsDMARDs.