Even though the patient who has rheumatoid arthritis (RA) is more likely to acquire osteoporosis, but tight control of disease activity may bring a positive effect on bone metabolism.

A team of researchers conducted a study to evaluate if bisphosphonate use is still relevant to improve bone mineral density (BMD) in RA patients whose disease activity was tightly regulated and glucocorticoid dose was decreased. This study was sub-analysis of the 10-year prospective cohort Total Management of Risk factors in Rheumatoid arthritis patients to lower morbidity and mortality (TOMORROW) which started from 2010.

BMD was compared between RA patients (n-192) and age-and sex-matched volunteers between 2010 and 2013 using dual-energy X-ray absorptiometry (DXA) in whole body mode. After that, ratios of changes in BMD (%ΔBMD) were defined to examine the factors affecting the increase in BMD among the patients using multivariate logistic regression analysis.

It was found that BMD was significantly lower in the patients than in the controls at all surveyed sites during 2010 and 2013. The %ΔBMD of the total spine was found to be considerably higher among the treated patients than without bisphosphonate (6.2 vs. 1.8%). Multivariate logistic regression analysis showed the use of bisphosphonate as a major contributing factor for the increase in BMD. While

other factors like use of biologic agents, decreasing glucocorticoid dose, and control of disease activity were not considerably related to any improvement in BMD. The BMD was found to be lower among patients with RA than non-RA controls.

The study concluded that use of Bisphosphonates was significantly associated with an increase in BMD of the spine over a span of 3 years. Also, the use of Bisphosphonates was found to be essential for keeping the BMD in RA patients under the control of inflammation and disease activity.