Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Effects of Biologics on Bone Metabolism of Patients with Rheumatoid Arthritis.

Okano,  Tadashi, Tada,  Masahiro, Wakitani,  Shigeyuki, Nakamura,  Hiroaki, Koike,  Tatsuya

Background:

Rheumatoid arthritis (RA) is associated with systemic bone loss, subchondral bone erosion and cartilage degradation. Biologics therapy has proven efficacious in improving both disease activity and focal bone erosions in patients with RA. We investigated the effects of biologics on bone mineral density (BMD) and biochemical markers in Japanese RA patients.

Objectives:

To examine whether treatment with biologics prevents loss of BMD in patients with RA, and to study the changes in markers of bone metabolism during biologics treatment.

Methods:

123 (103 women, 20 men, 55.8±12.9 years old) patients with active RA, who were treated with biologics (Infliximab:93, Etanercept:27, Tocilizumab:3) during 1 year, were included in this study. The disease duration was 13.0±12.8 years. The BMD of the lumbar spine and total hip (DXA:QDR-4500) was measured at baseline and after at least more than one year. As bone metabolic marker, serum bone specific alkaline phosphatase;BAP and urine type I collagen cross-linked N-telopeptide;NTX was measured at baseline and after at least more than one year. 33 patients received bisphosphonates while 84 patients were under oral glucocorticoid, we also assessed these effect.

Results:

After biologics treatment, the BMD of the lumbar spine did not reduced from 0.865±0.159 to 0.871±0.149 g/cm2 (p=0.22). Similarly, hip BMD did not reduced from 0.726±0.139 to 0.717±0.141 g/cm2 (p=0.12). The BMD of the hip in patients who have received glucocorticoid without bisphosphonates (n=55) showed significantly decreases from 0.755±0.136 to 0.738±0.140 g/cm2 (p=0.03) compared with patients not receiving glucocorticoid or receiving glucocorticoid with bisphosphonates. Moreover, the BMD of lumbar spine has increased from 0.818±0.151 to 0.838±0.150 g/cm2 (p=0.04) in patients who were administered with bisphosphonates (n=32). In whole patients, BAP was not significantly changed from 27.1±12.4 to 26.2±11.8 U/L (p=0.41), NTX was significantly decreased from 66.0±67.9 to 51.9±37.7 nmol/mmol CRE (p<0.01).

Conclusion:

The BMD of the lumbar spine and hip did not reduced after treatment with biologics. However our data provide additional evidence, to maintain BMD, dose reduction of glucocorticoid or the introduction of bisphosphonate should be required, even if biologics are administered.

Table 1. Analysis of the effect of biologics on BMD

 Lumbar BMD Femoral BMD 
 BaselineFinalPBaselineFinalP
All patients (n =123)0.865 ± 0.1590.871 ± 0.1490.220.726 ± 0.1390.717 ± 0.1410.12
G - (n = 39)0.890 ± 0.1650.897 ± 0.1530.410.752 ± 0.1550.751 ± 0.1550.99
G + (n = 84)0.854 ± 0.1560.859 ± 0.1460.360.714 ± 0.1300.701 ± 0.1320.06
BP - (n = 90)0.882 ± 0.1590.884 ± 0.1470.850.755 ± 0.1360.738 ± 0.1400.03
BP + (n = 33)0.818 ± 0.1510.838 ± 0.1500.040.640 ± 0.1080.657 ± 0.1270.23
G - B - (n = 32)0.906 ± 0.1710.913 ± 0.1570.550.775 ± 0.1580.768 ± 0.1620.44
G + B - (n = 58)0.869 ± 0.1520.868 ± 0.1410.80.745 ± 0.1240.723 ± 0.1260.02
G - B + (n = 7)0.816 ± 0.1150.827 ± 0.1210.270.652 ± 0.09890.679 ± 0.0980.12
G + B + (n = 26)0.818 ± 0.1610.841 ± 0.1590.070.636 ± 0.1130.651 ± 0.1350.56
G: glucocorticoid, BP: bisphosphonate

Table 2. Analysis of the effect of biologics on bone markers

 BAP NTX 
 BaselineFinalPBaselineFinalP
All patients (n = 123)27.1 ± 12.426.2 ± 11.80.4166.0 ± 67.951.9 ± 37.70.006
G - (n = 39)30.8 ± 16.327.9 ± 11.90.2187.0 ± 10658.1 ± 53.50.03
G + (n = 84)25.3 ± 9.6925.3 ± 11.80.9955.7 ± 33.248.9 ± 26.80.09
BP - (n = 90)27.4 ± 12.426.8 ± 12.60.6874.1 ± 75.655.8 ± 41.30.001
BP + (n = 33)26.2 ± 12.624.0 ± 8.910.2441.0 ± 21.039.9 ± 19.30.86
G - B - (n = 32)30.7 ± 15.828.5 ± 12.40.4497.6 ± 11967.3 ± 57.60.07
G + B - (n = 58)25.8 ± 10.126.0 ± 12.80.962.1 ± 34.449.9 ± 28.90.01
G - B + (n=7)31.2 ± 19.225.5 ± 10.50.1850.6 ± 20.926.3 ± 9.640.03
G + B + (n=26)24.1 ± 8.5923.4 ± 8.460.7336.8 ± 20.345.9 ± 19.60.12
G: glucocorticoid, BP: bisphosphonate

To cite this abstract, please use the following information:
Okano, Tadashi, Tada, Masahiro, Wakitani, Shigeyuki, Nakamura, Hiroaki, Koike, Tatsuya; The Effects of Biologics on Bone Metabolism of Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :981
DOI: 10.1002/art.28748

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