Long-Term Effects of Rheumatoid Arthritis Treatments on Bone Mineral Density: 8-Year-Follow-Up Data from Real-World...

Area of Science:

• Rheumatology
• Bone Metabolism
• Pharmacological Treatments

Background:

• Long-term effects of rheumatoid arthritis (RA) therapies on bone mineral density (BMD) are not fully understood.
• Evaluating BMD trajectories in RA patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs) is crucial for clinical practice.

Purpose of the Study:

• To assess BMD changes over an 8-year period in RA patients receiving csDMARDs versus bDMARDs.
• To compare BMD trajectories between treatment groups in a real-world setting.

Main Methods:

• Observational cohort study of 312 RA patients (2001-2016).
• BMD measured by dual-energy X-ray absorptiometry at baseline and years 1, 2, 3, 5, 8.
• Longitudinal BMD changes analyzed using multivariable linear mixed-effects models, adjusted for confounders.

Main Results:

• BMD remained stable for the first two years in both csDMARD and bDMARD groups.
• Beyond two years, modest declines were noted at hip sites, while lumbar spine BMD showed no significant change in pointwise analysis.
• Mixed-effects models revealed significant treatment group-time interactions for lumbar spine and total hip BMD, indicating differential trajectories. bDMARDs were associated with less pronounced BMD decline compared to csDMARDs.

Conclusions:

• BMD trajectories differ between RA patients treated with bDMARDs and csDMARDs over an 8-year follow-up.
• bDMARD therapy appears to be associated with a less pronounced decline in lumbar spine and total hip BMD compared to csDMARD monotherapy.
• Continuous bone health monitoring is essential for RA patients, regardless of treatment regimen.