Efficacy of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis of randomized controlled trial.

BACKGROUND

Rheumatoid arthritis (RA) can lead to significant bone destruction, which may occur locally near inflamed joints or systemically. As patients age, they often experience increased bone erosion around affected joints, heightened osteoclast activity, and systemic inflammation, which collectively result in bone loss. This condition is commonly referred to as osteopenia or osteoporosis.

METHODS

A systematic search was conducted across multiple databases, including PubMed, Web of Science, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) published on the use of denosumab in treating osteoporosis in patients with rheumatoid arthritis. The primary focus was to evaluate the impact of denosumab on various clinical measures, including bone mineral density (BMD), joint erosion scores, and overall joint maintenance. We performed a meta-analysis of six selected studies, all of which utilized these common metrics. The number of studies included in the analysis of each outcome varied depending on data availability in the original studies, with all included studies meeting our quality assessment criteria.

RESULTS

The results from these studies suggest that denosumab is effective in preventing further joint damage and bone loss in rheumatoid arthritis patients with osteoporosis. The data revealed a significant improvement in BMD, joint erosion scores, and joint narrowing scores in patients treated with denosumab compared to controls. These findings indicate the potential of denosumab as a preventive treatment for joint deterioration in RA patients with osteoporosis.

CONCLUSION

Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis. However, further studies with larger sample sizes and long-term follow-up are necessary to confirm these findings and to comprehensively assess the long-term safety profile, including potential adverse events such as hypocalcemia, osteonecrosis of the jaw, and atypical femoral fractures.