Influence of bisphosphonate therapy on bone geometry, volumetric bone density and bone strength of femoral shaft in postmenopausal women with rheumatoid arthritis

Abstract

BackgroundThere is evidence that postmenopausal women with rheumatoid arthritis (RA) on glucocorticoid (GC) therapy and bisphosphonate (BP) have an increased risk for atypical subtrochanteric and atypical diaphyseal femoral fracture (AFF). The underlying mechanism has not been elucidated so far. Using peripheral quantitative computed tomography (pQCT), the aim of the present study was to compare bone geometry, volumetric bone mineral density (vBMD) and bone strength of femoral shaft in BP-treated and BP-naïve postmenopausal women with RA.MethodsProspective cross-sectional pQCT scans were taken at 33 % of total femur of BP-treated and BP-naïve RA patients. Bone parameters of the two groups were compared and correlated to disease characteristics and muscle cross-sectional area (CSA).ResultsA total of 60 consecutive postmenopausal RA patients, 20 with BP therapy and 40 BP-naïve, were included in the study. The median age of the subjects was 63.5 years (range 48–85 years), and median disease duration (RA) was 12.0 years (range 2–47 years). Height and weight of the patients of the two groups were comparable. Women in the BP group were on average 4.3 years older (p = 0.044), and duration since menopause was on average 5.76 years longer (p = 0.045). In the BP group, there was a 13.31 % reduced muscle cross-sectional area around the proximal thigh (p = 0.013); cortical CSA was smaller by 5.3 % (p = 0.043); however, total and medullary CSA, as well as cortical vBMD and the polar bone stress–strain index of the femoral shaft were similar in the two groups. In regression analysis, age, time since menopause and muscular CSA were significant factors determining cortical CSA, cortical thickness and femoral index (p < 0.05). Regression model showed no significant effect of BP therapy on bone geometry and density of the femoral diaphysis at 33 %.ConclusionDifferences in cortical CSA between BP-treated and BP-naïve postmenopausal RA patients were found to be associated only with differences in age, time since menopause and muscle cross-sectional area around the proximal thigh. In interpreting our results, it should be kept in mind that BP was given only to patients with increased fracture risk. This fact might have a confounding effect on our findings of differences between the two groups.

Zoledronic acid ameliorates the effects of secondary osteoporosis in rheumatoid arthritis patients

“…In this study, we demonstrated that treatment with ZOL alone has little effect on RA-derived secondary osteoporosis, but that when it is combined with MTX it reduces both RA inflammation and bone destruction. Previous studies have shown that for women with postmenopausal RA, whose femoral bone density is correlated with the cross-sectional area of the proximal thigh muscle and the time since menopause, bisphosphonate treatment alone has no significant effect on the bone density of the femoral shaft [13]. On the contrary, in other studies from women with postmenopausal RA and a history of corticosteroid treatment, DAS28 score and bone density of the lumbar spine and femoral neck were significantly improved after 12 months of treatment with alendronate or risedronate along with the original RA treatment.…”

“…These drugs have been shown to inhibit bone resorption of osteoclasts, reduce bone turnover rate, increase bone strength, protect articular cartilage, and have anti-inflammatory effects [10]. These therapeutic effects have been demonstrated in senile and postmenopausal osteoporosis, but results from studies of RA-associated osteoporosis are inconclusive [12, 13]. In this study, we aimed to determine the efficacy of ZOL alone or in combination with MTX for the prevention and treatment of bone destruction in RA patients.…”

Patient-reported effectiveness and safety of Pamidronate in NSAIDs-refractory chronic recurrent multifocal osteomyelitis in children

“…A heated debate has recently arisen on the long-term consequences of their effects on bones [29]. Moreover, Bisphosphonate-associated osteopetrosis once reported by Whyte et al [30] may be nothing more than a coincidence, given the significant enhancement of bone mineral density shown by other authors [31][32][33]. However, between 2005 and 2010 alone, WHO counted more than 800 fragility fracture reports that could have been related to Bisphosphonates therapy [34][35][36].…”