The Effect of TNF Inhibition on Bone Density and Fracture Risk and of IL17 Inhibition on Radiographic Progression and Bone Density in Patients with Axial Spondyloarthritis: a Systematic Literature Review
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Purpose of Review
Osteoporosis in axial spondyloarthritis may be modified by therapy. The purpose of this systematic review is to describe (i) the effect of TNFi on BMD, (ii) the effect of secukinumab on BMD, and (iii) the effect of secukinumab on radiographic disease progression in axSpA.
We searched PubMed, Embase, and Cochrane using the following retrieval languages: spondyloarthritis, ankylosing spondylitis, TNF, IL-17, x-rays, and osteoporosis. Twenty-nine studies were included; 27 re: TNFi and BMD, and 2 re: IL-17 blockers and x-ray progression. TNFi over 2–4 years increased BMD of the lumbar spine (3.2–14.9%) and hip (2.26–4.7%) without reducing vertebral fractures. Secukinumab reduced radiographic progression; none (73%) and minimal (79%) at 4 years. No data on IL-17 blockade and bone were found.
TNFi therapy improves bone density but not vertebral fracture rates. Secukinumab improves symptoms and may slow radiographic progression. Data is lacking regarding the effects of secukinumab on BMD and fractures. These are important questions which may impact the choice of therapy.
KeywordsAxial spondyloarthritis Ankylosing spondylitis Osteoporosis Bone density TNF inhibitors IL-17 Secukinumab Radiographic progress Vertebral fracture
Tumor necrosis factor (TNF) inhibitor
Randomized control trial
Preferred reporting items for systematic review and meta-analysis
Modified Stoke Ankylosing Spondylitis Spinal Score
American College of Rheumatology
Occiput to wall
Bath Ankylosing Spondylitis Functional Index
The authors thank Haley Tornberg—research assistant.
DA, EMS, and SMG contributed to the conception and design of the review and assessed all papers, data extraction, and quality assessment. DA, EMG, RG, and SMG performed the literature search. DA drafted the paper; EMS and SMG revised the article for important intellectual content. All authors gave final approval of the version to be published.
Compliance with Ethical Standards
Conflict of Interest
Dr. Goodman reports grants from Novartis, personal fees from Novartis, personal fees from Pfizer, personal fees from UCB, grants from Horizon, outside the submitted work.
Dr. Ashany reports grants from Novartis, outside the submitted work.
Emily M. Stein and Rie Goto declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Ethics Approval and Consent to Participate
Consent for Publication
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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