Impact of Disease-Modifying Anti-Rheumatic Drugs on Bone Healing
Table of Contents
Published October 25, 2024, and updated October 25, 2025 13:53:05
Understanding the Connection
Disease-modifying anti-rheumatic drugs (DMARDs) are commonly prescribed to manage inflammatory conditions like rheumatoid arthritis. Though, their impact on bone union following trauma or orthopedic procedures is a growing area of concern. Recent research indicates a complex relationship,with certain DMARDs potentially hindering the natural bone healing process.
how dmards May Affect Bone Union
DMARDs work by suppressing the immune system, which can inadvertently affect bone metabolism. Specifically, some DMARDs interfere with osteoblast function – the cells responsible for building new bone - and can reduce bone mineral density. This interference can lead to delayed union, non-union, or impaired fracture healing, especially in patients undergoing procedures like fracture fixation, arthrodesis (joint fusion), or bone grafting.
Specific DMARDs and Their Effects
The extent of impact varies depending on the specific DMARD used. Methotrexate, a frequently prescribed DMARD, has been shown to potentially impair bone healing. Similarly, TNF-alpha inhibitors, another class of DMARDs, may negatively affect bone formation and remodeling. Conversely, some DMARDs, like sulfasalazine, appear to have a less pronounced effect on bone union.
Clinical Implications and Patient Considerations
For patients requiring orthopedic interventions, a thorough assessment of their DMARD regimen is crucial. clinicians should carefully weigh the risks and benefits of continuing DMARD therapy during the perioperative period. Strategies to mitigate potential negative effects include temporarily adjusting DMARD dosages,switching to alternative medications with less impact on bone metabolism (when clinically appropriate),and optimizing bone health through vitamin D and calcium supplementation.
Further research is needed to fully elucidate the long-term effects of DMARDs on bone healing and to develop tailored management strategies for these patients. Close monitoring of fracture healing, bone density, and overall bone health is essential for individuals on DMARD therapy who undergo trauma or orthopedic surgery.
