#4-29E. Unmasking the Silent Threat: b/tsDMARDs and Bone Loss in Rheumatoid Arthritis (Arthritis Rheumatol, 2026)

Does controlling inflammation in rheumatoid arthritis (RA) automatically guarantee the prevention of systemic bone loss? In a long-term, multicenter observational study, researchers investigated the changes in bone mineral density (BMD) over five years in patients with active RA treated with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). They found that while clinical disease activity significantly improved, patients not receiving anti-osteoporotic medications experienced a significant decline in T-scores at the femoral neck and radius. The most critical clinical takeaway is that suppressing inflammation with b/tsDMARDs alone is insufficient to arrest bone loss; concurrent anti-osteoporotic therapy is essential for maintaining BMD. However, when critically appraising this study, one must consider its single-arm observational design, which leaves room for residual confounding factors, and the potential missing of asymptomatic cases due to a reliance on reported fractures. For practicing physicians, this study is paramount as it underscores the necessity of managing osteoporosis as an independent entity in RA, highlighting that regular BMD assessments and targeted osteoporotic treatments are indispensable alongside daily arthritis control.

Citation: Aritomi T, Tanaka Y. Biological/targeted synthetic DMARDs do not arrest bone loss in patients with rheumatoid arthritis: a long-term multicenter observational study. Arthritis Rheumatol. 2026. DOI: 10.1002/art.70125

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