Does abatacept improve bone mineral density in patients with rheumatoid arthritis?

This study investigated if abatecept has an effect on bone mineral density in patients with rheumatoid arthritis. They found that patients taking abatacept have higher bone mineral density in the head of the femur bone. 

Rheumatoid arthritis (RA) is chronic (long-term) condition that is caused by inflammation in the joints. Patients with RA have a greater risk of developing bone metabolism disorders. Throughout life, bone is degraded and regenerated through a natural process called bone metabolism. Bone mineral density (BMD) measures bone metabolism. Low BMD causes bone weakness. Patients with RA are often diagnosed with osteoporosis, a condition where bones become weak. 

There is some evidence to show that certain medications used to treat RA can improve BMD. Patients with RA are treated with medications called anti-rheumatic disease-modifying drugs or DMARDs. Abatacept is a DMARD that suppresses inflammation by regulating a cell type called cytotoxic T lymphocytes. It may also affect bone formation. 

This study investigated if abatacept had any effect on BMD in patients with RA.

This study included 165 patients with RA. Patients were assigned to receive either abatcept (every 4 weeks) or another DMARD (depending on doctor’s recommendations). The trial lasted 48 weeks. BMD and bone metabolic markers (BMMs) were then assessed in the femoral head (top of the femur) and the lumbar spine.

Patients treated with abatacept had higher BMD (+0.97%) in the femoral neck compared to patients treated with other DMARDs (-2.19%). There was no difference in BMD in the lumbar spine. Statistical analysis suggests abatacept use is the most important influencing factor on BMD in the femoral head. There were no differences in BMMs between the groups. During the study disease activity improved in both groups however, abatacept patients had higher disease activity compared to non-abatecept patients at the end of the study. 

This study concluded that patients taking abatacept have higher bone mineral density in the head of the femur bone.

There was a high dropout rate in this study – approximately 35%. Larger, long-term studies are needed to assess the effects of abatacept.

If you have any concerns regarding bone health and treatment for rheumatoid arthritis, please discuss this with your physician.