Comparison of the efficacy of denosumab and bisphosphonates for treating secondary osteoporosis in patients with rheumatoid arthritis

Abstract

Objectives: This study aimed to investigate the efficacy of denosumab (compared with that of bisphosphonates) for preventing secondary osteoporosis and inflammation caused by excessive bone resorption in Japanese rheumatoid arthritis (RA) patients never previously treated for osteoporosis.

Methods: Ninety-eight patients with coexisting RA and osteoporosis were enrolled. The patients were subdivided by whether they were treated with denosumab (n = 49) or traditional bisphosphonates (n = 49). RA disease activity, bone turnover markers, and bone mineral density (BMD) were compared between the two groups before treatment, and after 6 and 12 months of treatment.

Results: There was no significant difference between the groups in any of the disease activity indices and BMD at any of the measured time points. With regard to bone metabolism, denosumab significantly reduced bone-specific alkaline phosphatase at 6 and 12 months compared with pretreatment, but had no effect on tartrate-resistant acid phosphatase 5b levels, suggesting an effect on the bone formation rate, but not on the bone resorption rate.

Conclusions: Neither denosumab nor bisphosphonates could suppress inflammation or RA disease activity, but denosumab significantly suppressed a marker of bone metabolism in Japanese RA patients never previously treated for osteoporosis.

Keywords:

• Bisphosphonates
• Bone metabolism
• Denosumab
• Rheumatoid arthritis

Acknowledgments

We wish to thank Drs. Seiya Miyamoto, Toshiaki Aizawa, Hiroshi Aonuma, Nobuhiro Ishizawa, Hiroki Ito, Masakazu Urayama, Kunio Ebata, Masashi Oba, Masaaki Ogino, Takeshi Kashiwagura, Yoichi Kataoka, Keiji Kamo, Hiroaki Kijima, Koji Kudo, Natsuo Konishi, Moto Kobayashi, Tsutomu Sakuraba, Takeshi Sato, Tsuyoshi Shirahata, Kazuhiro Syoji, Norio Suzuki, Hiroshi Tazawa, Takayuki Tani, Yasuki Tamura, Syuichi Chida, Hiroyuki Tsuchie, Yoshihiro Tsutsumi, Takeshi Nagasawa, Hidekazu Abe, Hideaki Noguchi, Koji Nozaka, Hiromi Morita, Shin Yamada, Kunitaka Yan, Hidetoshi Watanabe, and Wataru Watanabe in the AORA registry for data collection.

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.