Stephanie Siu1, Boulos Haraoui2, Robert Bissonnette3, Louis Bessette4, Camille Roubille5, Vincent Richer6, Tara Starnino7, Collette McCourt8, Alexandra McFarlane9, Patrick Fleming10, John Kraft11, Charles Lynde11, Wayne Gulliver12, Stephanie Keeling9, Jan Dutz8, Janet E Pope1. 1. Western University, London, Ontario, Canada. 2. Centre Hospitalier de l'Universite de Montreal and Institut de Rhumatologie de Montreal, Montreal, Quebec, Canada. 3. Inovaderm Research, Montreal, Quebec, Canada. 4. Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec, Canada. 5. University of Montreal Hospital Research Center and Notre-Dame Hospital, Montreal, Quebec, Canada. 6. Saint Luc Hospital, Montreal, Quebec, Canada. 7. Sacre-Coeur Hospital of Montreal and The University of Montreal, Montreal, Quebec, Canada. 8. University of British Columbia, Vancouver, British Columbia, Canada. 9. University of Alberta, Edmonton, Alberta, Canada. 10. University of Toronto, Toronto, Ontario, Canada. 11. Lynde Dermatology, Markham, Ontario, Canada. 12. Memorial University, St. John's, Newfoundland, Canada.
Abstract
OBJECTIVE: To examine the impact of antirheumatic drugs on bone mineral density (BMD) in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis using a systematic review. METHODS: Electronic databases were systematically searched for randomized controlled trials. Studies were grouped based on disease, treatment, and site of BMD measurement. Change in BMD (ΔBMD) from baseline to end of study was recorded. Standardized mean difference (SMD) of ΔBMD between treatment and controls was standardized for meta-analyses and 95% confidence intervals (95% CIs) were calculated. RESULTS: Treatment effects on BMD were not the primary outcomes of the trials. Thirteen studies were eligible (11 RA, 2 AS, 0 PsA, and 0 psoriasis). For RA, significantly less hand bone loss was seen with tumor necrosis factor inhibitors (TNFi; SMD ΔBMD 0.33 [95% CI 0.13, 0.53], P = 0.001, I(2) = 0%) and glucocorticoids (SMD ΔBMD 0.51 [95% CI 0.20, 0.81], P = 0.001, I(2) = 0%). TNFi had no significant effect on lumbar spine and hip BMD. Glucocorticoids were associated with a negative effect on lumbar spine (SMD ΔBMD -0.30 [95% CI -0.55, -0.04], P = 0.02, I(2) = 52%), but not hip BMD. For AS, a significant increase in BMD was seen with TNFi at the lumbar spine (SMD ΔBMD 0.96 [95% CI 0.64, 1.27], P < 0.001, I(2) = 16%) and hip (SMD ΔBMD 0.38 [95% CI 0.13, 0.62], P = 0.003, I(2) = 0%). Data were insufficient to perform meta-analyses in PsA and psoriasis or for other antirheumatic drugs. CONCLUSION: In RA, TNFi and glucocorticoids appeared to attenuate hand bone loss. TNFi did not impact lumbar spine and hip BMD and glucocorticoids had negative effects on lumbar spine and no effect on hip BMD. In AS, TNFi was associated with improved lumbar spine and hip BMD.
OBJECTIVE: To examine the impact of antirheumatic drugs on bone mineral density (BMD) in rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis using a systematic review. METHODS: Electronic databases were systematically searched for randomized controlled trials. Studies were grouped based on disease, treatment, and site of BMD measurement. Change in BMD (ΔBMD) from baseline to end of study was recorded. Standardized mean difference (SMD) of ΔBMD between treatment and controls was standardized for meta-analyses and 95% confidence intervals (95% CIs) were calculated. RESULTS: Treatment effects on BMD were not the primary outcomes of the trials. Thirteen studies were eligible (11 RA, 2 AS, 0 PsA, and 0 psoriasis). For RA, significantly less hand bone loss was seen with tumor necrosis factor inhibitors (TNFi; SMD ΔBMD 0.33 [95% CI 0.13, 0.53], P = 0.001, I(2) = 0%) and glucocorticoids (SMD ΔBMD 0.51 [95% CI 0.20, 0.81], P = 0.001, I(2) = 0%). TNFi had no significant effect on lumbar spine and hip BMD. Glucocorticoids were associated with a negative effect on lumbar spine (SMD ΔBMD -0.30 [95% CI -0.55, -0.04], P = 0.02, I(2) = 52%), but not hip BMD. For AS, a significant increase in BMD was seen with TNFi at the lumbar spine (SMD ΔBMD 0.96 [95% CI 0.64, 1.27], P < 0.001, I(2) = 16%) and hip (SMD ΔBMD 0.38 [95% CI 0.13, 0.62], P = 0.003, I(2) = 0%). Data were insufficient to perform meta-analyses in PsA and psoriasis or for other antirheumatic drugs. CONCLUSION: In RA, TNFi and glucocorticoids appeared to attenuate hand bone loss. TNFi did not impact lumbar spine and hip BMD and glucocorticoids had negative effects on lumbar spine and no effect on hip BMD. In AS, TNFi was associated with improved lumbar spine and hip BMD.
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