Secukinumab and Adalimumab on Bone Health in Psoriasis: A Longitudinal Cohort Study

Psoriasis is associated with skeletal comorbidities, but longitudinal data on bone outcomes in patients receiving biologics are limited.

To compare bone mineral density (BMD) and bone turnover marker trajectories among patients with psoriasis initiating secukinumab or adalimumab.

In this retrospective cohort study, 364 patients with psoriasis who initiated secukinumab or adalimumab between 2021 and 2024 were screened. Of these, 50 patients had a valid baseline dual-energy X-ray absorptiometry (DXA) assessment and at least one post-baseline DXA assessment, contributing 128 DXA assessments in total. In addition, 91 patients had a valid baseline bone-turnover-marker measurement and at least one post-baseline measurement, contributing 265 biomarker observations. Longitudinal trajectories were compared using covariate-adjusted, overlap-weighted linear mixed-effects models including treatment, time, and treatment-by-time interaction terms.

Secukinumab was associated with more favorable lumbar spine (β = 0.039; 95% CI, 0.019-0.059; P<0.001) and femoral neck BMD trajectories (β = 0.022; 95% CI, 0.005-0.039; P=0.012). Secukinumab was also associated with increased osteocalcin and reduced CTX trajectories, whereas P1NP did not differ significantly.

Limitations include the retrospective single-center design, modest sample size, treatment imbalance, surrogate outcomes, and potential residual confounding.

Compared with adalimumab, secukinumab was associated with more favorable longitudinal BMD trajectories and a bone turnover profile consistent with increased formation and reduced resorption in patients with psoriasis.