Biologics for RA Could Protect Against Rapid Bone Loss

With an increasingly brighter spotlight on osteoporosis, it was time for a sit down in order to assess things and progress. Indeed, the International Osteoporosis Foundation (IOF) Chronic Inflammation and Bone Structure (CIBS) Working Group has a new review indicating that early and aggressive treatment of rheumatoid arthritis (RA) with biologic drugs, specifically biological disease-modifying anti-rheumatic drugs (DMARDs), may be most effective in halting progressive bone loss in patients with RA.

As stated in the November 7, 2016 news release, the working group concluded that, “Early and ‘aggressive’ treatments were more effective in rapidly achieving a low level of inflammation and halting the progressive loss of bone. Therapies targeting specific cytokines and its signaling pathways with biologic DMARDs may protect the skeleton and should be introduced as soon as possible. However, it should be noted that outcomes in these clinical studies were based mostly on changes in biological markers and only a few reported modifications on BMD [bone mineral density] or localized osteoporosis. Only three retrospective studies reported reduction in fracture risk after anti-TNF [tumor necrosis factor] therapy. The TNF blockade studies showed that, even in RA patients not responsive to treatment, a protective effect on bone was observed suggesting the possibility that anti-TNF therapy may restore coupling of the bone remodeling independently of its anti-inflammatory action. Lack of efficacy of TNF blockade on hand bone loss was found, despite its preservation of BMD in lumbar spine and hip.”

“Better results regarding localized bone loss were observed with anti-IL6 [interleukin 6] treatment. Very few studies reported inhibition of bone loss after rituximab and abatacept treatment. Anti-RANKL [receptor activator of nuclear factor kappa-B ligand] therapy showed beneficial effects in the preservation of bone mass in RA, especially in juxta-articular osteoporosis, although this treatment cannot alter the inflammatory process. New non-biologic therapies but potent inhibitors of the cytokine network may offer future options for skeleton preservation in RA.”

Co-author Cristiano Zerbini M.D., director of the Centro Paulista de Investigaçao Clinica in Sao Paolo, Brazil, told OTW, “Biologic therapies for rheumatoid arthritis (RA) are mainly used by rheumatologists. Many aspects of this autoimmune disease including the bone effects of inflammation are firstly seen and treated by rheumatologists. By lowering the joint inflammation during arthritis clinical treatment, we saw that the patient was also protected against bone loss. The knowledge of this protection and the action of the biologic drugs on bone has been described in recent years and we hope that this manuscript published by Osteoporosis International may help to broadcast this scientific information.”

“The most important aspect of this manuscript is that by lowering the disease activity we are also protecting the patient against bone loss not only because of the action of the biologic drugs on the inflammatory process but also by improving the everyday life of our patients allowing them to return to their activities and exercises. The return to physical activities also protects the skeleton against bone loss.”