Background/Purpose: Changes in bone turnover marker (BTM) are known to offer an information regarding a dynamics of bone remodeling, treatment outcome in primary osteoporosis (OP). However, this has not been robustly investigated in real-world OP patients with rheumatoid arthritis (RA). The aim of this study is to investigate a serial change of BTMs after initiation of antiresoptive therapy in patients with active RA and OP, and compared it with newly diagnosed primary patients.

Methods: By retrospective reviewing of medical records, two groups of study population was designated. Group1is patients who newly diagnosed with active RA and OP both, and started antiresoptive therapy (bisphosphonate or selective estrogen receptor modulator ) with a concomittant start of diseas-modifying immunosuppressive agent and oral glucocorticoid (above 5mg prednisolone equivalent per day). Group2 is patients who newly diagnosed with pirmary OP. Along with demogrphic parameters, biologic maker of bone formation (osteocalcin) and bone resorption (serum telopeptide of type I collagen (CTX)) was checked on starting and after 3-6months, 12months of therapy. BMD by DEXA was checked on starting and after 12months of treatment. A non-parametric comparison of BTMs, DEXA value between two groups were done. Spearmann’s correlation and multivariate regression analysis on the effect of followed-up BTM level to good responder after 12months treatment was investigated.

Results: The mean age of gorup1 (34patients, all female) was 58.5±11.7 years old, which was significantly younger then group2 (37patients, all female, 65,8±7.9 years old). The achievement of T-score>-2.5 on lumbar spine or hip (reimbursement guideline of Korean FDA to halt medication for 1year) was 14patients (41.2%) in group1 and 15patients (40.5%) in group2. Supression of BTM after 3-6months of antiresorptive treatment was sustainable in group1, 2 and more evident in bisphosphonate group. In group1, the achievement of T-score>-2.5 was associated with the achievement of low disease activity during treatment of RA and OP. The effect of BTM level at initiation or after 3-6months antiresoptive treatment on 1year increment of bone density was not statistically significant in after adjusting demographic parameters and concomittent medication.

Conclusion: BTM suppression and increment of bone density after antiresorptive treatment in RA patients was comparable with response of primary OP. A patient with high RA disease activity during OP medication showed less increment of bone density.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implication-of-bone-turnover-marker-follow-up-during-antiresorptive-therapy-in-patients-with-active-rheumatoid-arthritis-on-immunosuppresssive-agents/