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Bone Abstracts (2013) 1 CU2.5 | DOI: 10.1530/boneabs.1.CU2.5

ECTS2013 Clinical Update Clinical Update 2 (6 abstracts)

The effect of anti-inflammatory treatments (except GC) on bone

Willem Lems


VU University Medical Centre, Amsterdam, The Netherlands.


Inflammatory joint diseases like rheumatoid arthritis (RA), as well as other rheumatic conditions such as ankylosing spondylitis and systemic lupus erythematosus, comprise a heterogeneous group of joint disorders that are all associated with extra-articular side effects, including bone involvement. Disease activity, immobility and treatment with (high dose) glucocorticoids are the main factors that increase the risk of osteoporotic fractures, on top of the background fracture risk based on, amongst others, age, BMI, and gender (Bultink 2012).

Although systemic osteoporosis and an elevated vertebral and nonvertebral fracture rate can be found in RA, the disease is mainly characterized by the presence of inflammatory synovitis and pannus, leading to destruction of joint cartilage and (local) bone loss. In general, both the generalized and the local bone loss are larger in patients with active RA. Adequate control of disease activity, for instance with TNF-blocking agents or other biologics prevents, bone loss.

In RA patients the effect of TNF blockade on bone has been studied by Vis et al., who showed in a cohort of 102 RA patients (median age 53 years and median disease duration 8 years) that treatment with infliximab in combination with a stable dosage of MTX led to a statistically significant decrease (P<0.05) of 20% in serum CTX levels (bone resorption), whereas PINP levels (bone formation) were increased slightly at 46 weeks. RANKL levels also significantly decreased by 33% (P<0.001) in this study, while OPG more or less remained stable, leading to an improvement of the RANKL/OPG ratio. The changes in markers of bone resorption paralleled the decrease in disease activity (Vis 2006)

The favorable changes in BMD were also resulted in the absence of the usually occurring bone loss at the spine and hips in RA during treatment with infliximab and MTX, which was later confirmed in a study with adalimumab (Wijbrantds 2009). Recently, favorable changes in bone markers in treatment of RA were also observed in RA patients treated with rituximab and tocilizumab. All these data point in the same direction: with biologics both local and generalized bone loss can be prevented in patients with active RA.

Volume 1

European Calcified Tissue Society Congress 2013

Lisbon, Portugal
18 May 2013 - 22 May 2013

European Calcified Tissue Society 

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