Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We investigated the effect of oral alendronate (AL) therapy on bone turnover and osteoclast activating factors in early RA.
A 90 day randomized placebo controlled trial of 40 mg oral AL/day compared with placebo in 32 patients with early mild disease. Serum interleukin 1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), IL-6, beta2microglobulin (beta2m), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), osteocalcin/bone gla protein (BGP), urinary crosslinks, and urinary hydroxyproline (HP) measured at 30 and 90 day intervals were the variables measured.
A significant decrease of IL-1, IL-6, TNF-alpha, and beta2m was observed after 30 days, persisting after 90 days in the AL group, but with no significant variation in the placebo group. A significant decrease of ESR and CRP was observed after 90 days in the AL group, but with no significant variation after 30 days in the AL group, and after both 30 and 90 days in the placebo group. A significant decrease of BGP, HP, and urinary crosslinks was observed after 30 days, persisting after 90 days in the AL group, but with no significant variation in the placebo group.
Our study demonstrates that alendronate reduces bone turnover in early RA and may have a possible antiarthritic effect. Because of the mild early form of the disease in the study cohort, further evaluations are required to confirm this effect.