The Impact of Conventional and Biological Disease Modifying Antirheumatic Drugs on Bone Biology. Rheumatoid Arthritis as a Case Study

Clin Rev Allergy Immunol. 2016 Aug;51(1):100-9. doi: 10.1007/s12016-016-8547-6.

Abstract

The bone and the immune system have a very tight interaction. Systemic immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA), induce bone loss, leading to a twofold increase in osteoporosis and an increase of fragility fracture risk of 1.35-2.13 times. This review focuses on the effects of conventional and biological disease modifying antirheumatic drugs (DMARDs) on bone biology, in the context of systemic inflammation, with a focus on RA. Published evidence supports a decrease in osteoclastic activity induced by DMARDs, which leads to positive effects on bone mineral density (BMD). It is unknown if this effect could be translated into fracture risk reduction. The combination with antiosteoclastic drugs can have an additional benefit.

Keywords: Bone; DMARDs; RA.

Publication types

  • Review

MeSH terms

  • Animals
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use
  • Antirheumatic Agents / pharmacology*
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / immunology
  • Arthritis, Rheumatoid / metabolism
  • Arthritis, Rheumatoid / pathology
  • Biomarkers
  • Bone Resorption / drug therapy
  • Bone Resorption / genetics
  • Bone Resorption / immunology
  • Bone Resorption / metabolism
  • Bone and Bones / drug effects*
  • Bone and Bones / metabolism*
  • Humans
  • Immune System / cytology
  • Immune System / drug effects
  • Immune System / immunology
  • Immune System / metabolism
  • Methotrexate / pharmacology
  • Methotrexate / therapeutic use
  • Molecular Targeted Therapy
  • Osteoclasts / metabolism

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Biomarkers
  • Methotrexate