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

Jun Xie,Guilin Ouyang,Yubiao Gu,Chengxin Gao,Shaohua Li,Xiuwei Han,Lianbo Xiao,Lin Zheng

doi:10.1186/s13018-019-1492-3

Abstract

BackgroundSecondary osteoporosis may occur in patients with rheumatoid arthritis (RA), causing irreversible joint damage and disability. Bisphosphonates, the recently developed bone resorption inhibitors, have demonstrated significant therapeutic effects on senile and postmenopausal osteoporosis. This study evaluated the efficacy and safety of zoledronic acid (ZOL), with or without methotrexate (MTX), for the prevention and treatment of bone destruction in RA patients.MethodsWe recruited 66 RA patients with symptoms of secondary osteoporosis. They were randomized into three treatment groups—combined treatment with MTX and ZOL, ZOL monotherapy, or MTX monotherapy—in two consecutive 6-month periods. The participants were followed for 12 months. At the end of each treatment period, improvement in disease activity, bone destruction, and fracture risk were evaluated.ResultsCombined treatment with ZOL and MTX had significantly better clinical efficacy compared with either ZOL or MTX monotherapy (P < 0.05). The combination significantly improved the lumbar spine and hip BMD and reduced FRAX scores, suggesting that ZOL combined with MTX reduces bone loss and risk of hip fracture in RA patients with secondary osteoporosis.ConclusionZOL has a synergistic effect when combined with MTX, inhibiting RA disease activity, reducing fracture risk, and improving quality of life in RA patients with secondary osteoporosis.Trial registrationChinese Clinical Trial Registry, ChiCTR1800019290. Registered 3 November 2018–Retrospective registered, http://www.chictr.org.cn/showproj.aspx?proj = 31758

Highlights

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease with an estimated global prevalence of 1 to 3% [1,2,3]
Improvement in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) was observed with combined treatment and MTX monotherapy (Table 1)
The combination provided greater improvement in visual analog scale (VAS) score compared with MTX monotherapy after 6 months of treatment and compared with both zoledronic acid (ZOL) and MTX monotherapy after 12 months (P < 0.05) (Table 1)

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease with an estimated global prevalence of 1 to 3% [1,2,3]. The chronic local and systemic inflammation observed in RA patients is often accompanied by multiorgan dysfunction. 15 to 36% of RA patients develop osteoporosis [6, 7] as a complication as early as 2 years after disease onset, increasing risks of local and systemic bone erosion, decreased bone density, and increased fracture risk [8]. Secondary osteoporosis may occur in patients with rheumatoid arthritis (RA), causing irreversible joint damage and disability. This study evaluated the efficacy and safety of zoledronic acid (ZOL), with or without methotrexate (MTX), for the prevention and treatment of bone destruction in RA patients

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Conclusion