Impact of Various Rheumatoid Arthritis Treatments on Bone Mineral Density in Postmenopausal Women

Aim:The objective of this study was to evaluate the impact of various treatment options on bone mineral density (BMD) in postmenopausal women with rheumatoid arthritis (RA). Material and Methods:A retrospective analysis was conducted on the data of 163 postmenopausal women, including 121 RA patients meeting the 2010 American College of Rheumatology/European League Against Rheumatism criteria and 42 healthy controls. RA patients were categorized into four groups based on their treatment regimens: Group 1, receiving conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone; Group 2, receiving csDMARDs in combination with glucocorticosteroids (GCs); Group 3, receiving csDMARDs with GCs and biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs); and Group 4, receiving b/tsDMARDs combined with methotrexate. Data collected included demographic information, BMD T-scores at lumbar spine (L1-L4), femoral neck, total hip, and serum calcium, and vitamin D levels. Results:RA patients had significantly lower BMD T-scores at L1-L4, femoral neck, and total hip compared to controls (p=0.041, p=0.026, and p=0.003, respectively). Among treatment groups, patients receiving csDMARDs with GCs exhibited greater bone loss, particularly in femoral neck scores, compared to other regimens (all p≤0.005). Conversely, b/tsDMARDs showed a protective effect on BMD, mitigating bone loss despite the use of low-dose GCs. Conclusion:This study demonstrates that RA treatments significantly influence BMD in postmenopausal women. b/tsDMARDs appear to mitigate the adverse effects of GCs on bone health, while prolonged GC use is associated with greater bone loss, especially in the csDMARDs group.