Improvements apparent after 12 months.
Among patients diagnosed with rheumatoid arthritis who also fulfill the criteria for osteoporosis, treatment with denosumab appears to improve or maintain bone mineral density after a year of therapy, researchers in Japan reported for the virtual meeting of the European League Against Rheumatism.

In a consecutive series of 140 patients — 135 of whom were women – there was a 5.9% improvement from baseline in bone mineral density at the lumbar spine (P<0.01); a 4% increase in bone mineral density at the proximal femoral (P<0.01) and a 1.2% improvement in bone mineral density at the femoral neck (P=0.36), reported Shosei Anno, MD, of Osaka Social Medical Center.

“Denosumab improved bone mineral density in patients with rheumatoid arthritis independently regardless of disease activity, use of biological disease-modifying anti-rheumatic drugs, the concomitant type of vitamin D, and pre-treatment of osteoporosis,” Dr. Anno reported in an abstract prepared for the meeting that was scheduled for Frankfurt, Germany, but was canceled due to the Covid-19 pandemic.

In Dr. Anno’s study, patients were evaluated by dual energy X-ray absorptiometry at baseline and one year after treatment. The 140 patients included 75 patients considered as in remission or having low disease activity; 65 patients were diagnosed with moderate or high disease activity.

The researchers reported that when the patients were compared by disease activity state, the effect of denosumab remained consistent with the entire cohort. In those with low disease activity, there was a 6.4% improvement in lumbar spine bone mineral density compared with a 5.3% improvement among those with active disease (P=0.91); at the proximal femoral, the improvement was 3% among the patients with low disease activity and 5.1% in the group with active disease (P=0.73); and there was a 2% improvement in the femoral neck among the patients with low disease activity, compared to a 0.3% improvement among those with active disease (P=0.1).

Dr. Anno reported a similar finding when looking at 45 patients treated with biologics — including 23 on anti-tumor necrosis factor drugs, 13 on tocilizmab, 7 on abatacept, and 2 on tofacitinib — compared with 93 patients who were not being treated with biologics. The pattern also persisted when the patients were stratified by the type of vitamin D — active form or native form of the vitamin — or whether they were pre-treated with bisphosphonate and/or teriparatide or were not on osteoporosis pre-treatment.

The study was one of several presented at EULAR that examined the treatment and outcomes of patients who were diagnosed with both rheumatoid arthritis and osteoporosis.

In one of those studies, researchers reported that when teriparatide is administered to combat progression of rheumatoid arthritis, the favorable changes obtained with teriparatide are attenuated by co-administration of biologics and/or glucocorticoids.

But when biologics and glucocorticoids were used together, the difference was dramatic, reported Yuji Hirano, MD, of Toyohashi Municipal Hospital.

In their abstract presentation, Dr. Hirano and colleagues said that after 24 months, patients who were receiving teriparatide but were not receiving either biologics or glucocorticoids achieved a 15.5% increase in bone mineral density when measured at the lumbar spine. If the patients were taking teriparatide and biologics, the improvement in bone mineral density at 24 months was 12.7%. If the patients were on teriparatide and glucocorticoids, the bone mineral density increased 11.9%. But if the patient was on both biologics and glucocorticoids, the improvement was diminished to an 8.1% increase at 24 months. There were no statistically significant differences between the groups, Dr. Hirano reported.

However, the pattern was similar when analyzing bone mineral density in the total hip, the researchers reported. The increase with patients only on teriparatide was 6.4% at 24 months compared with an increase of 1.5% among patients on teriparatide as well as biologics and glucocorticoids (P=0.03).

“This study suggested that concomitant use of biologics and glucocorticoids inhibited the increase in bone mineral density induced by teriparatide treatment in patients with rheumatoid arthritis, particularly total hip bone mineral density,” Dr. Hirano reported.

In a third study, researchers found that about 25% of the patients diagnosed with systemic lupus erythematosus — who were on glucocorticoids and were also diagnosed with chronic kidney disease — were not given treatment to combat osteoporosis, even though osteoporosis is exacerbated by kidney disease and use of glucocorticoids.

“Osteoporosis is one of the most important adverse effects of glucocorticoids in patients with systemic lupus erythematosus,” reported Ken-Ei Sada, MD, of the Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences. “Because osteoporosis is accelerated by chronic kidney disease, more attention should be paid to the treatment for osteoporosis in lupus patients with chronic kidney disease. Many treatment options for osteoporosis have emerged recently, but treatment status in patients with lupus is not elucidated.” In their abstract, the research team accessed data from a lupus registry of nationwide institutions. The researchers enrolled 917 patients, 88% of whom were women. The average age was 44 years. Bisphosphonates were administered to 388 (42%) patients; vitamin D supplements were given to 448 (49%) patients; Calcium supplements were prescribed to 36 (4%) patients; denosumab was prescribed to 20 (2%) patients; and teriparatide was administered to 14 (2%) patients.

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Sada noted that the records indicated 225 patients (25%) did not receive any treatment.

“About a quarter of patients with lupus did not take any treatment for osteoporosis,” Sada reported. “Treatment for osteoporosis might be strengthened to prevent bone damage in lupus patients with chronic kidney disease.”


Hirano disclosed relevant relationships with Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, and Eli Lilly.

Anno disclosed no relevant relationships with industry.

Sada disclosed relevant relationships with GSK and AstraZeneca.





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