Patients with RA have lower bone density than healthy individuals but whether biologics improve bone density remains controversial. A Japanese group had an interesting poster called "Influence of Biologic Agents on BMD and Bone Mineral Markers in Patients with RA: Data from the Airtight Study."
This was a prospective, comparative study to investigate the effects of Abatacept (ABT) and other bDMARDS on bone metabolism. 165 RA patients were divided into ABT (n=50) and non-ABT groups (n=115). The non-ABT group included infliximab, etanercept, adalimumab, tocilizumab and golimumab. Percent change in BMD was measured by DEXA. Bone markers, NTx and BAP were also measured.
Results showed a statistically significant improvement in femoral neck BMD in the ABT group but not the lumbar spine after 1 year. Markers of bone turnover were also no different between groups. There was no difference in DAS28 scores, suggesting the difference in BMD was not on the basis of disease activity. Steroid use was also the same in both groups as was bisphosphonate use, but the usage rate of bisphosphonates was disappointingly low at roughly 30% in both groups.
I certainly wouldn't call the results Airtight but worthy of more research.
Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.View Full Bio