Osteoporosis Treatment in Patients on Hydroxychloroquine and Leflunomide

Primary Treatment Options

• Denosumab can be administered with extended dosing intervals up to every 8 months if necessary to minimize healthcare encounters, making it particularly practical for patients already managing complex medication regimens 1

Drug Interaction Considerations

• Hydroxychloroquine and leflunomide can be safely continued during osteoporosis treatment, as recommended by the American College of Rheumatology 2, 3
• These conventional synthetic DMARDs (csDMARDs) have mild immunomodulatory effects compared to other immunosuppressants, according to the European League Against Rheumatism 4

Clinical Approach Algorithm

• For patients with contraindications to oral bisphosphonates, denosumab 60 mg subcutaneously every 6 months can be used as an alternative, as suggested by the American College of Rheumatology 1
• Continue hydroxychloroquine and leflunomide without dose adjustment, as they do not interfere with osteoporosis treatment, as recommended by the American College of Rheumatology 2, 3