We aimed to determine whether tumor necrosis factor inhibitors (TNFi) have beneficial effects on bone mineral density (BMD) in rheumatoid arthritis (RA) patients with osteoporosis receiving bisphosphonate. A total of 199 RA patients, who were newly diagnosed with osteoporosis and receiving bisphosphonate between January 2005 and March 2017, were reviewed. Changes in BMD after 1 year were compared between patients treated with and without TNFi. The inverse probability of treatment weighting (IPTW) method using the propensity score was performed to minimize confounding factors, and logistic regression analysis was applied to identify any factors associated with significant BMD improvement (≥ 3%) at the lumbar spine and femur neck. Among patients receiving bisphosphonate, 29 were exposed to TNFi, and 170 patients were not exposed. The percentage change in BMD and the proportion of significant improvements at the lumbar spine and femur neck were similar between patients treated with and without TNFi, before and after IPTW adjustment. In addition, the disease activity score 28 (DAS28) with three variables [adjusted odds ratio (OR) 0.741, 95% confidence interval (CI) 0.592-0.927, p = 0.009] and cumulative steroid dose (adjusted OR 0.639, 95% CI 0.480-0.851, p = 0.002) were inversely associated with an improvement in BMD. Conversely, TNFi use was not associated with any improvement in BMD after adjustment by IPTW using the propensity score. TNFi did not influence BMD improvement in RA patients with osteoporosis receiving bisphosphonate, suggesting that TNFi cannot be considered as a preferred therapeutic option for increasing BMD.

中文翻译：

---

TNF抑制剂对接受双膦酸盐治疗的类风湿关节炎患者骨矿物质密度的影响：一项回顾性队列研究。

我们旨在确定肿瘤坏死因子抑制剂（TNFi）是否对接受双膦酸盐治疗的骨质疏松症的类风湿关节炎（RA）患者的骨矿物质密度（BMD）有有益的影响。回顾了2005年1月至2017年3月之间新诊断为骨质疏松并接受双膦酸盐治疗的199名RA患者。比较接受和不接受TNFi治疗的患者1年后BMD的变化。使用倾向评分进行治疗加权加权（IPTW）的逆概率，以最大程度地减少混杂因素，并应用逻辑回归分析确定与腰椎和股骨颈BMD显着改善（≥3％）相关的任何因素。在接受双膦酸盐治疗的患者中，有29名暴露于TNFi，170名患者未暴露。在IPTW调整前后，接受或不接受TNFi的患者的BMD百分比变化和腰椎和股骨颈明显改善的比例相似。此外，疾病活动评分28（DAS28）具有三个变量[调整后的优势比（OR）0.741，95％置信区间（CI）0.592-0.927，p = 0.009]和累积类固醇剂量（调整后的OR 0.639，95％CI 0.480-0.851，p = 0.002）与BMD的改善呈负相关。相反，在使用倾向评分通过IPTW进行调整后，TNFi的使用与BMD的任何改善均无关。TNFi不会影响接受双膦酸盐治疗的骨质疏松症RA患者的BMD改善，提示TNFi不能被视为增加BMD的首选治疗选择。