Denosumab effective in improving BMD and microarchitecture in rheumatoid arthritis

In a recent study, a pre-specified exploratory analysis has shed light on the beneficial effects of denosumab on bone mineral density (BMD) and bone microarchitecture in patients suffering from rheumatoid arthritis (RA) and undergoing conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) treatment. The findings were published in Journal of Bone and Mineral Metabolism.

The study, conducted as an open-label, parallel-group investigation, involved the random assignment of 46 RA patients to two groups. The first group received continuous treatment with csDMARDs plus denosumab, while the second group received only continuous csDMARD therapy for a duration of 12 months. BMD and bone microarchitecture were assessed through dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT).

Out of the initial 46 participants, 43 patients were included in the full analysis set. The mean age of the participants was 65.3 years, with 88.4% of them being female, and 60.5% having osteoporosis, a condition characterized by weak and brittle bones.

The results of the study proved highly promising. Both groups exhibited an increase in areal BMD of the lumbar spine at 6 and 12 months compared to baseline measurements, but the rise was more substantial in the csDMARDs plus denosumab group. Furthermore, the csDMARDs plus denosumab group showed significant improvement in areal BMD at the total hip and femoral neck, while the group undergoing only csDMARD therapy did not display the same level of improvement.

Perhaps most impressively, the study revealed notable improvements in cortical volumetric BMD and cortical thickness of the distal tibia in the csDMARDs plus denosumab group at both 6 and 12 months. In stark contrast, the csDMARD therapy alone group experienced decreases in these measurements. Additionally, trabecular bone parameters of the distal tibia improved significantly in the csDMARDs plus denosumab group after 12 months, while no such improvement was observed in the other group.

These findings provide compelling evidence that denosumab supplementation may be an advisable option for RA patients undergoing csDMARD treatment, as it can lead to increased BMD and improved bone microarchitecture. Such improvements are vital in the management of RA, as the disease often leads to bone loss and deterioration.

Reference:

Chiba, K., Iwamoto, N., Watanabe, K., Shiraishi, K., Saito, K., Okubo, N., Kawakami, A., & Osaki, M. (2023). Denosumab improves bone mineral density and microarchitecture in rheumatoid arthritis: randomized controlled trial by HR-pQCT. In Journal of Bone and Mineral Metabolism. Springer Science and Business Media LLC. https://doi.org/10.1007/s00774-023-01452-9