Background/Purpose:

The efficacy of biological agents in the treatment of chronic inflammatory arthropathies is well known, however, the effect of this therapy in bone metabolism has been scarcely evaluated. Therefore, the aims of this study were to analyze the effects of biological therapy on bone mineral density (BMD), bone turnover and the incidence of fractures in patients with chronic inflammatory arthropathies

Methods:

Prospective 2-year study including patients diagnosed with chronic inflammatory arthopathies initiating or switching biological therapy in a hospital day-care unit of a Rheumatology Department. Demographic data including diagnosis and duration of the disease, current biological agent and concomitant treatment (DMARD, glucocorticoids (GC)) were evaluated in all patients as were the following determinations at baseline and at 12 and 24 months: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), calcium, phosphate, 25-hydroxyvitamin D, parathyroid hormone (PTH), bone turnover markers of formation (P1NP and bone ALP) and  resorption (urinary NTX and serum CTX), bone densitometry (DXA) and spinal x-rays. Patients with chronic renal failure and/or known metabolic bone disease were excluded

Results:

Fifty-seven patients were included (84.2% female); mean age 50 ± 13.4 years; mean disease duration 14 ± 9.4 years. The diagnoses were: rheumatoid arthritis 73.7%, psoriatic arthritis 3.5%, ankylosing spondylitis 3.5%, undifferentiated spondyloarthropathy 3.5% and overlap syndrome 8.8%. 40.4% were biologic-naive patients and 59.6% switchers: 80.7% were receiving a non-anti tumour necrosis factor (TNF) agent and 19.3% a TNF antagonist; 77% received concomitant treatment with DMARDs. The number and dose of GC therapy significantly changed at two years from baseline. Thus, the number of patients on GC decreased from 73.7% to 56.1% (p=0.018) and the percentage of patients with a daily dose > 5 mg of prednisone from 48.8% to 32.2% (p=0.001). Also, a significant decrease in acute serum reactants (ESR, p=0.002; CRP, p=0.005) as well as in NTX (p=0.005) and PTH (p=0.03) values was found at 24 months with a trend to an increase in lumbar BMD compared to baseline (1.105 ± 0.101 vs 1.065 ± 0.175 g/cm², p=0.06); with no changes in total hip BMD (0.828 ± 0.126 vs 0.888 ± 0.146 g/cm², p=0.11). No fragility fractures were observed in the follow-up period

Conclusion:

Patients with chronic inflammatory arthopathies receiving biological therapy show a decrease in bone resorption markers and a preservation of lumbar BMD at 2 years, a finding which may be related with the reduction in glucocorticoid dose during therapy and the outcome of the inflammatory process

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-biological-therapy-in-bone-metabolism-in-patients-with-chronic-inflammatory-arthropathies/