2014 World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases: Osteoporosis in patients with rheumatoid arthritis: methotrexate compared with leflunomide treatment alone

40 patients with active rheumatoid arthritis were randomized to receive methotrexate or leflunomide to compare treatment effects on bone loss over a 12 month period. Upon analysis, bone mineral density (BMD) loss in the methotrexate group was significantly reduced at the femoral neck, total hip, and L2-4 spine compared to the leflunomide group. BMD loss at the hand was similar between the two groups. Subgroup analysis indicated an increase in BMD in patients treated with bisphosphonates, while a decrease in BMD was observed in those that did not undergo antirersorptive therapy.