Biological disease-modifying antirheumatic drugs (bDMARDs) are genetically engineered to act like natural proteins in the immune system which have a significant contribution to the treatment of RA for many years. This prospective study by Killinger Z et al. depicted that treatment with bDMARDS decreased the mean prednisone dose and led to an increase in the trabecular bone score (TBS).

Biologic treatment may influence the RA, as well as areal bone mineral density (aBMD). Decreased aBMD portrays that the fracture risk in RA patients only partially. The trabecular bone score (TBS), a novel texture parameter reflects the degradation of trabecular bone and hence could be used as a further parameter to foretell the risk of fragility fracture. This study aimed to compare the effects of bDMARDs and conventional synthetic (cs) DMARDs (methotrexate) on aBMD and TBS in active RA patients.

A 12-month prospective trial was executed in a total of 105 active RA patients. The cohort was divided into two groups: 84 patients in group 1 with a mean age 54 yrs treated with bDMARDs and 21 patients in group 2 with mean age 53 yrs treated with csDMARDs. The mean daily dose of prednisone at baseline was 6.2 and 6.6 mg (NS) between group 1 and 2. Patients with anti-osteoporotic treatment were not considered. All patients obtained calcium 600 mg and cholecalciferol 800IU. Lumbar spine (LS) and FN aBMD (by DXA) were calculated at baseline and after 1 year of treatment. TBS was generated using the TBS Insight software.

Treatment with bDMARDS initiated a decrease in mean prednisone dose and increase of 1.7% (p < 0.05) in TBS and OC levels of 26% (p < 0.001) except on aBMD and CTX after treatment. The TBS increased (2.7%, p < 0.05) significantly in premenopausal females within group 1. There was no effect of csDMARDS on measured parameters.

The treatment of patients suffering from active RA with bDMARDs in comparison to csDMARDS led to an increase in TBS, with a higher increment of TBS in premenopausal women, despite no change in aBMD.