Denosumab, cortical bone and bone erosions in rheumatoid arthritis

MD, both at trabecular and cortical sites, and has been showed to prevent metacarpal bone loss in patients with RA, and improve cortical porosity. An intriguing hypothesis is that the effects of denosumab in terms of prevention of bone erosions are mainly due to its positive effects on cortical BMD and porosity. We think that, in the future, treatment with agents not only targeting inflammation but improving cortical bone should deserve more consideration in order to achieve better prevention of bone erosions in RA. Non-responders to the DMARDs in terms of progression of bone erosions could be indeed the consequences of a concomitant osteoporosis. The lack of data about BMD might represent an important bias for meta-analysis on effects of DMARDs on radiographic progression of RA.