Pathogenic bone loss in rheumatoid arthritis: Mechanisms and therapeutic approaches

Rheumatoid arthritis (RA) is a systemic inflammatory disorder with progressive joint destruction being its hallmark feature. Conventional treatments, such as DMARDs, aim to inhibit the inflammation; however, over the past decade, major advances in our understanding of bone metabolism has given us the ability to directly treat the bone loss in RA. Although modern anti-inflammatory therapies, such as anti-TNF-α treatment, have resulted in a remarkable improvement in the treatment of RA, these treatments do not directly target bone destruction in the joint. The aim of this review is to demonstrate that antiresorptive therapies can prevent structural joint destruction, particularly in the early stages of anti-inflammatory treatment. A number of novel approaches targeting bone resorption are also becoming available.