A new review published in Calcified Tissue International highlights major advances in understanding and preventing bone loss in people with rheumatoid arthritis (RA), showing that modern antirheumatic therapies can significantly reduce the local and generalized bone loss in RA.
The paper, “ Osteoimmunology: Can We Prevent Bone Loss in Rheumatoid Arthritis with Modern Antirheumatic Drugs? ”, was authored by an international team of experts on behalf of the International Osteoporosis Foundation (IOF) Osteoimmunology Working Group.
Rheumatoid arthritis is a chronic inflammatory autoimmune disease that affects joints and bone health. In addition to causing painful joint inflammation and erosion, RA substantially increases the risk of osteoporosis and fractures. The review cites a previous meta-analysis reporting that patients with RA have approximately a 50% higher risk of fractures than the general population, with hip fracture risk more than doubling in some studies.
The authors describe how the emerging field of “osteoimmunology” — the interaction between the immune system and bone — has transformed understanding of RA-related bone damage. Inflammatory cytokines such as TNF-alpha, IL-1, and IL-6 stimulate bone-resorbing osteoclasts through the RANK/RANKL pathway, while simultaneously suppressing bone formation. Autoantibodies such as anticitrullinated protein antibodies (ACPAs) may potentially contribute to accelerated bone destruction, even in patients with otherwise controlled disease.
Professor Willem F. Lems, Amsterdam University, the Netherlands, and co-chair of the IOF Osteoimmunology Working Group, stated: “Importantly, our review concludes that modern therapies — including biologic disease modifying antirheumatic drugs (DMARDs), targeted synthetic DMARDs, and combinations of conventional therapies — can substantially slow or even halt both localized erosions and generalized bone loss in rheumatoid arthritis patients.”
Among the findings highlighted in the review:
The paper also reviews emerging imaging technologies such as high-resolution peripheral quantitative computed tomography (HR-pQCT), which can detect subtle bone erosions earlier and more sensitively than standard radiography. Recent studies cited in the review demonstrate that some erosions can partially repair under effective treatment — a concept previously thought unlikely in RA.
Despite these advances, the authors emphasize that important research questions remain, including the need for long-term fracture outcome studies, better understanding of bone quality beyond bone mineral density, and strategies to address residual fracture risk in patients whose inflammation is well controlled.
Professor Eugene McCloskey, University of Sheffield, UK and chair of the IOF Committee of Scientific Advisors added: “We are encouraged to see that the major advances in the field of osteoimmunology, combined with the introduction of powerful biologic therapies for rheumatoid arthritis, can substantially prevent both local and generalized bone loss in rheumatoid arthritis. These developments highlight how progress in immunology and targeted therapies is reshaping long-term outcomes for patients, moving treatment goals beyond symptom control toward preservation of skeletal health and prevention of disability.”
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Reference
Raterman HG, Adami G, Clark P, Haugeberg G, Morales Torres J, Vidal Neira L, Zakraoui L, Zerbini C, Messina OD, Lems WF; on behalf of the IOF Osteoimmunology Working Group. Osteoimmunology: Can We Prevent Bone Loss in Rheumatoid Arthritis with Modern Antirheumatic Drugs? Calcif Tissue Int 117, 55 (2026). https://doi.org/10.1007/s00223-026-01504-y
About IOF
The International Osteoporosis Foundation (IOF) is the world’s largest nongovernmental organization dedicated to the prevention, diagnosis, and treatment of osteoporosis and related musculoskeletal diseases. Its members — including committees of leading scientific researchers and 349 patient, medical, and research organizations across 152 countries — work together to make fracture prevention and healthy mobility a global healthcare priority.
www.osteoporosis.foundation @iofbonehealth
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Osteoimmunology: Can We Prevent Bone Loss in Rheumatoid Arthritis with Modern Antirheumatic Drugs?
11-Apr-2026