NSAIDs and radiographic progression in ankylosing spondylitis

Abstract

a subsequent study hinted at a possible increase in risk of fractures in NSAID users despite an increase in BMD. 9 Analysis of the Canadian Multicentre Osteoporosis Study on the effects of NSAIDs on BMD led to interesting findings. 10 The use of NSAIDs was associated with a decrease in BMD in men and increase in postmenopausal women who did not receive oestrogen replacement. 10 The authors concluded that the effect of NSAIDs seen in this study is a reflection of suppression of inflammation associated with the postmenopausal state, while the direct effect of prostaglandin inhibition on bone is manifest in men as a decrease in BMD. [...]there are few studies to inform the decision on whether NSAIDs should be continued when a biological agent is administered, although our recent experience provides supportive evidence for this approach. 4 Both for the pivotal phase 3 random control trials of biological agents in AS and current third-party coverage, inadequate control of symptoms by NSAIDs has become the criteria for use of anti-TNF agents. [...]the published literature on the effects of anti-TNF agents on bone formation is based largely on experience with NSAID non-responders.