Which factors determine the effect of Deno- sumab on bone structural damage in women with rheumatoid arthritis and osteoporosis?

Dr. Polina Kovalenko
V. A. Nasonova Research Institute
of Rheumatology Moscow, Russian Federation
E-Mail: polina_dydykina@mail.ru

Kovalenko P., Dydykina I., Smirnov A., Nasonov E.
V. A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation

RANK-ligand is essential for osteoclast development, activation, and survival and it is a key mediator of increased osteoclast activity in rheumatoid arthritis (RA). Denosumab is a monoclonal antibody that binds RANK-ligand. The aim of this study was to distinguish factors that determine the effect of denosumab in women with RA and osteoporosis (OP) on bone structural damage (erosions, joint space narrowing): anamnesis, clinical/laboratory markers, glucocorticoids (GC) intake, etc.

Material and methods

66 postmenopausal women (mean age 59,6±7,4) with RA (mean duration 17,7±10,4 years) and OP received s/c denosumab 60 mg every 6 months pro 12 months. RF-positive were 72%, ACCP – 74% of patients. 34 (49%) patients continued GC. At baseline and after 12 months it was carried out the x-ray of hands and feet (Sharp/ van der Heijde (SVH) score) and dual energy x-ray absorptiometry at 3 sites: lumbar spine, hip neck and distal forearm.


Table 1: The factors which influence a SVH score increase (n=66), p < 0.05.


After therapy it was noted that the erosion score was increased in 12% (n=8) patients (p=0.0117), the joint space narrowing score (JSN) in 9% (n=6) (p=0.027). Table 1 shows the most significant factors which influence SVH score dynamics (increase) after 12 months of denosumab therapy.


There was note that the increase of erosion score is associated with either lower BMD in L1-L4 (at baseline and after treatment) or back correlation with BMD increase in DF. Also, the higher cumulative GC dose and back correlation with BAP base level were observed at patients with increased erosion score. The only factors that we could reveal in patients with increased JSN score were surgical menopause in anamnesis and lower value of BMD dynamics (%) in DF after treatment. In general, it was a direct correlation between erosion score and JSN score.

Source: Published as abstract in „Osteoporosis International“