Osteoporosis in Rheumatic Diseases: Anti-rheumatic Drugs and the Skeleton

Dubrovsky, Alanna; Lim, Mie Jin; Lane, Nancy E.

doi:10.1007/s00223-018-0401-9

Cited by 50 publications

(26 citation statements)

References 91 publications

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“…Interestingly, the use of denosumab seems neither related to a higher risk for inflammatory activity (relapse of IBD), nor for an increased risk for infectious diseases [79]. This has been subject of study in rheumatoid arthritis but not in IBD [80], and effects on bone formation more than on bone resorption have been proposed when observing elevated concentrations of bone-specific alkaline phosphatase [81]. In addition, denosumab use seems to be associated with a rebound effect following discontinuation of therapy which may be considered to be a major flaw when using this drug in the relative young IBD population [82].…”

Section: Denosumab and Other New Bone Health-improving Agentsmentioning

confidence: 99%

Perspective on skeletal health in inflammatory bowel disease

Bodegraven

Bravenboer

2019

Osteoporos Int

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Osteopenia and osteoporosis are common features in inflammatory bowel disease (IBD), comprising both Crohn's disease and ulcerative colitis. Moreover, Crohn's disease is associated with increased fracture risk. The etiology of bone loss in IBD is multifactorial. It includes insufficient intake or absorption of calcium, vitamin D, and potassium; smoking; a low peak bone mass; a low body mass index; and decreased physical activity. In several studies, it has been shown that elevated concentrations of systemic and local pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interferon-γ (IFNγ), interleukin (IL)-1β, IL-4, IL-5, IL-6, IL-13, and IL-17, present in IBD patients are potentially detrimental for bone metabolism and may be responsible for bone loss and increased fracture risk. This perspective aims to review the current literature on the role of inflammatory factors in the pathophysiology of skeletal problems in IBD and to suggest potential treatment to improve bone health, based on a combination of evidence and clinical and pathophysiological reasoning.

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Section: Denosumab and Other New Bone Health-improving Agentsmentioning

confidence: 99%

Perspective on skeletal health in inflammatory bowel disease

Bodegraven

Bravenboer

2019

Osteoporos Int

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“…The RANK-RANKL system has been extensively studied in the context of osteoporosis related to chronic inflammatory disease. In fact, rheumatic diseases such as rheumatoid arthritis (RA) and ankylosing spondylitis are frequently associated with bone loss, both localized and systemic, and are characterized by an increased risk of osteoporotic fractures in all age groups [33] (Fig. 1).…”

Section: Osteoimmunologymentioning

confidence: 99%

Bone Metabolism in SARS-CoV-2 Disease: Possible Osteoimmunology and Gender Implications

Salvio

Gianfelice

Firmani

et al. 2020

Clinic Rev Bone Miner Metab

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Even though inflammatory conditions are known to exert adverse effects on bone metabolism, there are no published data regarding SARS-CoV-2 infection and subsequent fracture risk. We present a brief review of the molecular mechanisms linking inflammatory diseases to increased fracture risk/osteoporosis and of the therapeutic strategies that can prevent bone resorption in patients with inflammatory disease, focusing on the RANK-RANKL system. We also make some considerations on gender differences in infection response and on their implications for survival and for the consequences of COVID-19. Several inflammatory cytokines, especially IL-1, IL-6, and TNF-α, stimulate osteoclast activity, favoring bone resorption through the RANK-RANKL system. Data from the previous SARS-CoV outbreak suggest that the present disease also has the potential to act directly on bone resorption units, although confirmation is clearly needed. Even though the available data are limited, the RANK-RANKL system may provide the best therapeutic target to prevent bone resorption after COVID-19 disease. Vitamin D supplementation in case of deficiency could definitely be beneficial for bone metabolism, as well as for the immune system. Supplementation of vitamin D in case of deficiency could be further advantageous. In COVID-19 patients, it would be useful to measure the bone metabolism markers and vitamin D. Targeting the RANK-RANKL system should be a priority, and denosumab could represent a safe and effective choice. In the near future, every effort should be made to investigate the fracture risk after SARS-CoV-2 infection.

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“…Studies evaluating the skeletal effects of rituximab in rheumatological patients reported conflicting results. One study on rituximab treatment in patients with rheumatoid arthritis (RA), described an increase in lumbar spine BMD (bone mineral density) irrespective of clinical response, whereas in the femur, rituximab merely prevented bone loss, and only in responders (6). Another study suggested that treatment with rituximab reduced osteoclast activity as assessed by serum markers of bone resorption (7), and a recent study, also in RA patients (8), demonstrated a significant reduction in the femoral BMD with no effect in the spine.…”

Section: Introductionmentioning

confidence: 99%