Denosumab improves bone mineral density and microarchitecture in rheumatoid arthritis: randomized controlled trial by HR-pQCT

• Published in: Journal of bone and mineral metabolism Vol. 41; no. 6; pp. 797 - 806
• Main Authors: Chiba, Ko, Iwamoto, Naoki, Watanabe, Kounosuke, Shiraishi, Kazuteru, Saito, Kengo, Okubo, Naoki, Kawakami, Atsushi, Osaki, Makoto
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.11.2023; Springer Nature B.V
• Subjects: Bone density; Bone mineral density; Cancellous bone; Computed tomography; Dual energy X-ray absorptiometry; Medicine; Medicine & Public Health; Metabolic Diseases; Original Article; Orthopedics; Osteoporosis; Rheumatoid arthritis; Spine (lumbar); Tibia; HR-pQCT; Bone mineral density; Denosumab; Bone microarchitecture; Rheumatoid arthritis
• ISSN: 0914-8779; 1435-5604
• DOI: 10.1007/s00774-023-01452-9

Introduction This pre-specified exploratory analysis investigated the effect of denosumab on bone mineral density (BMD) and bone microarchitecture in patients with rheumatoid arthritis (RA) treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Materials and methods In this open-label, parallel-group study, patients were randomly assigned (1:1) to continuous treatment with csDMARDs plus denosumab or continuous treatment with csDMARD therapy alone for 12 months. BMD and bone microarchitecture were measured by dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT). Results Of 46 patients enrolled in the primary study, 43 were included in the full analysis set. The mean age was 65.3 years, 88.4% were female, and 60.5% had osteoporosis. Areal BMD of the lumbar spine increased from baseline to 6 and 12 months in both groups, but the increase was higher in the csDMARDs plus denosumab group. Areal BMD of the total hip and femoral neck increased from baseline to 6 and 12 months only in the csDMARDs plus denosumab group. Cortical volumetric BMD and cortical thickness of the distal tibia increased in the csDMARDs plus denosumab group at 6 and 12 months but decreased in the csDMARD therapy alone group. Trabecular bone parameters of the distal tibia improved only in the csDMARDs plus denosumab group at 12 months. Conclusion Denosumab may be recommended for patients with RA treated with csDMARDs to increase BMD and improve bone microarchitecture.