TOPLINE

Denosumab improved lumbar spine bone mineral density (BMD) more than alendronate in postmenopausal women with rheumatoid arthritis (RA) on long-term oral glucocorticoids (GCs), with a mean difference of 0.444% at 1 year. However, denosumab-treated patients showed a numerically higher fracture rate (8.1% vs 1.6%), though this difference did not reach statistical significance in the primary analysis.

METHODOLOGY

• A multicenter, retrospective cohort study compared denosumab with alendronate in postmenopausal RA patients on long-term oral GCs.
• A total of 295 patients from certain hospitals in China were included from January 2018 to December 2023, comprising 122 patients in the denosumab group and 173 in the alendronate group; the mean age of the cohort was around 63 years.
• Propensity score matching was performed, resulting in 62 matched pairs for analysis.
• The primary outcome was the incidence of any new fragility fracture during the first year following treatment initiation; secondary outcomes included 1-year changes in T-scores and areal BMD at femoral neck, total hip, and lumbar spine, as well as procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptide of type I collagen (CTx) concentrations at 1 year.
• Subgroup analyses were conducted based on history of regular RA treatment, baseline anti-citrullinated protein antibody status, and history of prior fragility fractures.

TAKEAWAY

• Denosumab-treated patients showed significantly greater improvement in lumbar spine areal BMD compared with alendronate-treated patients (mean difference, 0.444%; P = .025).
• The absolute risk difference for fracture was 3.2% (95% CI, -2.2% to 8.6%), with fracture rates of 8.1% in the denosumab group vs 1.6% in the alendronate group (P = .135).
• No significant between-group differences were observed in BMD changes at the femoral neck or total hip, or in bone turnover markers (P1NP and CTx) at 1 year.
• Subgroup analyses showed consistently higher estimated fracture risks with denosumab across all subgroups, though none reached statistical significance, and interaction tests revealed no significant effect modification.

IN PRACTICE

"Denosumab continues to be an effective choice for managing osteoporosis in this population, especially for patients needing substantial BMD gains. Nevertheless, clinical decisions should be tailored to individual patient characteristics, with special emphasis on long-term monitoring and fracture risk control in high-risk individuals... Further large-scale prospective studies with longer follow-up are needed to confirm the comparative effectiveness of these two drugs on fracture endpoints," the authors wrote.

SOURCE

The study was led by Mengmeng Chen, Department of Orthopaedic Surgery, The Third People's Hospital Health Care Group of Cixi, Ningbo, Zhengjiang, China. It was published online on August 17 in Therapeutic Advances in Musculoskeletal Disease.

LIMITATIONS

The retrospective design cannot exclude unmeasured confounders such as fall risk, frailty, renal function, adherence, calcium and vitamin D supplementation, and reasons for drug choice. The small matched cohort (62 patients per arm) and only 6 fracture events during 1-year follow-up resulted in insufficient statistical power and wide confidence intervals, precluding robust multivariable analysis.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.