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Meta-Analysis
. 2025 May 7;26(1):450.
doi: 10.1186/s12891-025-08688-8.

Efficacy of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis of randomized controlled trial

Tao Tang  1 , Bingwen Wan  1 , Alei Zhang  1 , Xu Zhang  1 , Xuqing Wang  1 , Shuiwei Mao  2
Affiliations
Meta-Analysis

Efficacy of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis: a meta-analysis of randomized controlled trial

Tao Tang et al. BMC Musculoskelet Disord. .

Abstract

Background: Rheumatoid arthritis (RA) can lead to significant bone destruction, which may occur locally near inflamed joints or systemically. As patients age, they often experience increased bone erosion around affected joints, heightened osteoclast activity, and systemic inflammation, which collectively result in bone loss. This condition is commonly referred to as osteopenia or osteoporosis.

Methods: A systematic search was conducted across multiple databases, including PubMed, Web of Science, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) published on the use of denosumab in treating osteoporosis in patients with rheumatoid arthritis. The primary focus was to evaluate the impact of denosumab on various clinical measures, including bone mineral density (BMD), joint erosion scores, and overall joint maintenance. We performed a meta-analysis of six selected studies, all of which utilized these common metrics. The number of studies included in the analysis of each outcome varied depending on data availability in the original studies, with all included studies meeting our quality assessment criteria.

Results: The results from these studies suggest that denosumab is effective in preventing further joint damage and bone loss in rheumatoid arthritis patients with osteoporosis. The data revealed a significant improvement in BMD, joint erosion scores, and joint narrowing scores in patients treated with denosumab compared to controls. These findings indicate the potential of denosumab as a preventive treatment for joint deterioration in RA patients with osteoporosis.

Conclusion: Denosumab demonstrates promising efficacy in maintaining bone health and preventing joint damage in rheumatoid arthritis patients with coexisting osteoporosis. However, further studies with larger sample sizes and long-term follow-up are necessary to confirm these findings and to comprehensively assess the long-term safety profile, including potential adverse events such as hypocalcemia, osteonecrosis of the jaw, and atypical femoral fractures.

Keywords: Denosumab; Meta; Osteoporosis; Rheumatoid arthritis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Civil Aviation General Hospital under acceptance number 2017(MH-003). Consent for publication: All human participants provided written informed consent before participation in the study in accordance with the Declaration of Helsinki. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Risk of bias graph
Fig. 4
Fig. 4
Forest plot of BMD of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
Fig. 5
Fig. 5
Forest plot of bone erosion score of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
Fig. 6
Fig. 6
Forest plot of joint space narrowing score of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
Fig. 7
Fig. 7
Forest plot of modified total sharp score of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
Fig. 8
Fig. 8
Forest plot of DAS28 of denosumab in treatment of osteoporosis in patients with rheumatoid arthritis
See this image and copyright information in PMC

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