From the Guidelines
Humira (adalimumab) is not recommended for the treatment of osteoporosis, as it may have negative effects on bone health, and instead, medications like bisphosphonates, denosumab, or teriparatide should be used to reduce the risk of fractures. Humira is a TNF-alpha inhibitor primarily used to treat inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, and ulcerative colitis [ 1 ]. While it effectively reduces inflammation in these conditions, it does not directly improve bone mineral density or prevent fractures associated with osteoporosis. In fact, some studies suggest that long-term use of TNF inhibitors like Humira, especially when combined with glucocorticoids, might contribute to bone loss.
Key Points to Consider
- The American College of Physicians recommends using bisphosphonates for initial pharmacologic treatment of primary osteoporosis to reduce the risk of fractures [ 1 ].
- Denosumab (Prolia) is suggested as a second-line pharmacologic treatment to reduce the risk of fractures in postmenopausal females diagnosed with primary osteoporosis who have contraindications to bisphosphonates [ 1 ].
- Teriparatide, abaloparatide, or romosozumab may be used for females with primary osteoporosis at very high risk of fracture [ 1 ].
- Calcium and vitamin D supplementation are also essential for maintaining bone health [ 1 ].
Treatment Approach
If you have both an inflammatory condition requiring Humira and osteoporosis, you would need separate treatment for each condition, and your doctor should monitor your bone health regularly. The treatment approach should prioritize medications that specifically target bone metabolism to either slow bone breakdown or stimulate new bone formation, rather than relying on Humira for osteoporosis treatment [ 1 ].
From the Research
Humera Effect on Osteoporosis
There is no direct evidence in the provided studies regarding the "humera effect" on osteoporosis.
Osteoporosis Treatment
- Bisphosphonates are safe and effective agents for the treatment and prevention of osteoporosis 2.
- They increase bone mass and reduce the risk of vertebral fractures in patients with established osteoporosis 2, 3.
- Alendronate and risedronate are the most studied bisphosphonates for osteoporosis treatment and have been shown to reduce the risk of hip and nonvertebral fractures 2, 3.
- The use of bisphosphonates has been limited due to the risk of rare side effects, and treatment duration has been restricted to up to 10 years with oral bisphosphonates and 6 years with intravenous zoledronic acid 3.
Bisphosphonates and Bone Strength
- Bisphosphonates reduce the risk of fracture by suppressing bone resorption and increasing bone strength 4.
- The mechanism by which bisphosphonates improve bone strength is not fully understood but probably involves complex effects on different components of bone strength, such as microarchitecture 5.
Treatment Strategies
- Sequential treatment, starting with a bone-building drug (e.g., teriparatide), followed by an antiresorptive, may provide better long-term fracture prevention for patients with severe osteoporosis and high fracture risk 3.
- Combining a bisphosphonate with other agents, such as estrogen or raloxifene, may produce greater gains in bone mass, but the effect on fracture risk is not clear 2.