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BACKGROUND: Osteoporosis is an extra-articular complication of rheuma­toid arthritis that results in increased risk of fractures and associated mor­bidity, mortality, and healthcare costs.OBJECTIVE: To evaluate changes in bone mineral density in a sample of rheumatoid arthritis (RA) patients on biological (anti tumor necrosis factor (TNF) alpha) and non-biological agent disease modifying antirheumatic drugs (DMARDs).PATIENTS & METHODS: A cross sectional study enrolled 60 RA patients diagnosed by rheumatologist according to the 2010 American College of Rheumatology/European League Against Rheumatism (2010 ACR/EULAR) classification criteria for RA. Thirty patient on biological agent (anti TNF alpha) and 30 patient on non-biological agent (DMARD). RA disease-related data wincluded disease duration, disease activity score index of 28 joints (DAS 28) and clinical disease activity index (CDAI), functional class, body mass index and treatment history. vitamin D level were measured in both groups. Bone mineral density was measured by dual energy x-ray absorptiometry of hip and lumber spines for patients. A T –score of equal or less than -2.5 standard deviation that of young healthy adults were taken as osteoporotic and scores between -1 to -2.5 standard deviation was taken as osteopenic.RESULTS: Prevalence of RA patients on biological agent (anti TNF alpha) who had osteoporosis was 1(3%) and 12(40%) were osteopenic, and in patients on non biological (DMARD), Osteoporosis was present in 8(26%) and osteopenia in 13(43%, p= 0.019).Vitamin D level in patient on biological agent (anti TNF alpha) was low in 24(80%) and normal in 6 (20%) patients. While in non biological agent (DMARD) it was low in 13(43.3%) and normal in 17(56.7%) of patients, p=0.003). Patients on biological agent (anti TNF alpha); 15 (50%) patients showed high calcium, 2(6.7%) low phosphorous, and 2(6.7%) high Alkaline phosphatase (ALP) while in patients on non biological agent the results were 10 patients( 33.3%) had high calcium, and 5(16.7%) had high ALP. There was a significant decrease in bone mineral density in RA patients on DMARDS while biological agent (anti TNF alpha) had a role in arrest bone loss in RA patients.CONCLUSIONS: There was a strong association between types of therapy and reduction of bone mineral density.

global journal of health science

Effects of Biological and Non Biological Agents (Disease Modifying Antirheumatic Drugs) on Bone Mineral Density in a Sample of Rheumatoid Arthritis Patients