Effect of TNF Inhibitors on Bone Mineral Density in Rheumatoid Arthritis Patients Receiving Bisphosphonate

Jung Sun Lee¹, Seokchan Hong², Doo-Ho Lim³, Jebum Won¹, Oh Chan Kwon², Ji Seon Oh², Yong-Gil Kim², Chang Keun Lee² and Bin Yoo², ¹Division of Rheumatology, Department of Internal Medicine,, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of (South), ²Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of (South), ³Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea, Republic of (South)

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Biologic agents, Osteoporosis and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, October 23, 2018

Title: Osteoporosis and Metabolic Bone Disease – Basic and Clinical Science Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: . This study aimed to investigate whether tumor necrosis factor inhibitors (TNFi) have beneficial effects on bone mineral density (BMD) in rheumatoid arthritis (RA) patients with osteoporosis receiving bisphosphonate (BP).

Methods: A total of 239 RA patients, who were diagnosed with osteoporosis and treated with BP between Jan 2005 and Mar 2017, were reviewed retrospectively. The BMD (g/cm²) of the lumbar spine, femur neck, trochanter, and total femur was measured by dual-energy X-ray absorptiometry. Changes in the BMD percentage were compared between patients treated with and without TNFi. Multivariate analysis was performed to identify the factors associated with improvement of BMD in RA patients receiving BP.

Results: Among 239 RA patients receiving BP, 35 patients were exposed to TNF inhibitors, and 204 patients were not exposed. The last follow-up BMD was obtained at a median of 2.23 (IQR, 1.13–4.25) years after the initial acquisition of BMD. An improvement in the BMD of the lumbar spine was observed for patients treated with BP; however, there was no significant difference in BMD between patients treated with and without TNFi (4.92% (IQR, 1.6–9.42) vs. 4.99% (IQR, 0.68–10.1), P = 0.437). In addition, BMD changes in the femur neck, trochanter, and total hip were not significantly different between the two groups (Table 1). Furthermore, in multivariate analysis, the use of TNFi was not associated with significant BMD improvement in any sites after adjusting for age, sex, RA duration, cumulative steroid dose, or intake of vitamin D. On the other hand, cumulative steroid dose was significantly associated with a lower improvement in BMD.

Conclusion: In RA patients with osteoporosis receiving BP, TNFi did not provide an additional beneficial effect on BMD improvement.

Table 1 BMD changes in patients treated with and without TNF inhibitors

	With TNFi (n=35)			Without TNFi (n=204)			Intergroup P value
	Baseline	Change, %	P value	Baseline	Change, %	P value	Intergroup P value
Lumbar	0.821 (0.11)	4.92	<0.001	0.795 (0.728–0.84)	4.99	<0.001	0.437
Femur neck	0.695 (0.14)	0.26	0.806	0.675 (0.102)	0.89	0.810	0.769
Trochanter	0.549 (0.01)	1.44	0.511	0.546 (0.102)	1.97	0.052	0.725
Femur total	0.765 (0.648–0.798)	0.59	0.512	0.714 (0.106)	0.69	0.549	0.701

Disclosure: J. S. Lee, None; S. Hong, None; D. H. Lim, None; J. Won, None; O. C. Kwon, None; J. S. Oh, None; Y. G. Kim, None; C. K. Lee, None; B. Yoo, None.

To cite this abstract in AMA style:

Lee JS, Hong S, Lim DH, Won J, Kwon OC, Oh JS, Kim YG, Lee CK, Yoo B. Effect of TNF Inhibitors on Bone Mineral Density in Rheumatoid Arthritis Patients Receiving Bisphosphonate [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/effect-of-tnf-inhibitors-on-bone-mineral-density-in-rheumatoid-arthritis-patients-receiving-bisphosphonate/. Accessed .

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