Osteoporosis International

, Volume 24, Issue 2, pp 423–432 | Cite as

Osteoporosis drug therapy strategies in the setting of disease-modifying agents for autoimmune disease

  • B. F. Ricciardi
  • J. Paul
  • A. Kim
  • L. A. Russell
  • J. M. Lane


The purpose of this systematic review is to evaluate the effects of methotrexate (MTX) and tumor necrosis factor-alpha (TNF-α) inhibitors on bone mineral properties in the clinical literature. A systematic review of the literature identifying relevant case reports, population-based studies, cohort studies, case control studies, and randomized controlled trials in Pubmed and Web of Science databases from inception to December 31, 2011 was conducted. The following keywords were used: “bone turnover,” “bone mineral density,” “TNF-α inhibitors,” “infliximab,” “adalimumab,” “etanercept,” and “MTX.” The bibliographies of all retrieved studies were also reviewed to identify additional articles. Based on these results, a rational drug therapy strategy was suggested for treating osteoporosis in patients with inflammatory disease. MTX and TNF-α inhibitors do not appear to have an adverse effect on BMD in patients with inflammatory disease. Their negative effects on BMD and bone turnover in pre-clinical models appear to be outweighed by their anti-disease effects in clinical studies. Treatment with MTX or TNF-α inhibitors has no adverse effect on BMD in patients with inflammatory disease. Future studies will focus on developing optimal drug strategies when combining DMARDs with anti-osteoporotic agents in this patient population.


Bone mineral density Disease-modifying agents Methotrexate Osteoporosis Tumor necrosis factor-alpha inhibitors 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • B. F. Ricciardi
    • 1
  • J. Paul
    • 2
  • A. Kim
    • 3
  • L. A. Russell
    • 4
  • J. M. Lane
    • 1
  1. 1.Metabolic Bone Disease ServiceHospital for Special SurgeryNew YorkUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA
  3. 3.College of Physicians and SurgeonsNew YorkUSA
  4. 4.Department of RheumatologyHospital for Special SurgeryNew YorkUSA

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