Zoledronic acid ameliorates the effects of secondary osteoporosis in rheumatoid arthritis patients
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(2019) 14:421
RESEARCH ARTICLE
Open Access
Zoledronic acid ameliorates the effects of secondary osteoporosis in rheumatoid arthritis patients Jun Xie1,2, Shaohua Li1*, Lianbo Xiao2*, Guilin Ouyang2, Lin Zheng2, Yubiao Gu2, Chengxin Gao2 and Xiuwei Han2
Abstract Background: Secondary 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. Methods: We 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. Results: Combined 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. Conclusion: ZOL 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 registration: Chinese Clinical Trial Registry, ChiCTR1800019290. Registered 3 November 2018–Retrospective registered, http://www.chictr.org.cn/showproj.aspx?proj = 31758 Keywords: Zoledronic acid, Inflammation, Osteoporosis, Rheumatoid arthritis
Introduction Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease with an estimated global prevalence of 1 to 3% [1–3]. In China, nearly 5 million people have RA [4, 5], causing a significant economic and social burden. RA is characterized by chronic symmetrical and progressive polyarthritis accompanied by pain, stiffness, and swelling in the patients’ joints. Pathological changes in the synovial membrane of the joint include chronic * Correspondence: [email protected]; [email protected] 1 Department of Orthopedics, The Tenth People’s Hospital Affiliated to Nanjing Medical University, No. 301 Yanchangzhong Road, Shanghai 200000, China 2 Department of Joint Orthopedics, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 504 Xinhua Road, Shanghai 200052, China
inflammation, hyperplasia, and vasospasm, as well as the invasion of the articular cartilage, subchondral bone, ligaments, and tendons. These changes cause the destruction of the articular cartilage, bone, and the joint capsule, eventually leading to irreversible joint deformity and loss
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