Bone mineral density in rheumatoid arthritis patients on antirheumatic therapies: a systematic review

Rheumatoid Arthritis (RA) is associated with increased fracture risk due to systemic bone loss. Whilst new disease modifying antirheumatic drugs (DMARD) have improved disease control, their impacts on bone mineral density (BMD) remains controversial. This systematic review investigates the effects of conventional synthetic (cs), biologic (b), and targeted synthetic (ts) DMARDs on BMD in RA patients. 13,340 records were screened, with 46 studies meeting the inclusion and exclusion criteria, published on PROSPERO (CRD42024534452). Included studies were analysed by their use of specific DMARD, glucocorticosteroids (GCS), antiosteoporotic therapy (AOT) and disease activity. csDMARD appear beneficial to BMD, and on the balance of evidence bDMARD and tsDMARD appear to have a greater effect on BMD. Encouragingly, early data suggests some csDMARD, bDMARD, tsDMARD may be superior to others, however, further research is required to confirm this. Future researchers should consider DMARD mechanism of action on BMD and examine the role of specific csDMARD, bDMARD, and tsDMARD in large cohort studies and trials.