Secukinumab and Adalimumab on Bone Health in Psoriasis: A Longitudinal Cohort Study.

BACKGROUND: Psoriasis is associated with skeletal comorbidities, but longitudinal data on bone outcomes in patients receiving biologics are limited. OBJECTIVE: To compare bone mineral density (BMD) and bone turnover marker trajectories among patients with psoriasis initiating secukinumab or adalimumab. METHODS: In this retrospective cohort study, 364 patients with psoriasis who initiated secukinumab or adalimumab between 2021 and 2024 were screened. Of these, 50 patients had a valid baseline dual-energy X-ray absorptiometry (DXA) assessment and at least one post-baseline DXA assessment, contributing 128 DXA assessments in total. In addition, 91 patients had a valid baseline bone-turnover-marker measurement and at least one post-baseline measurement, contributing 265 biomarker observations. Longitudinal trajectories were compared using covariate-adjusted, overlap-weighted linear mixed-effects models including treatment, time, and treatment-by-time interaction terms. RESULTS: Secukinumab was associated with more favorable lumbar spine (β = 0.039; 95% CI, 0.019-0.059; P<0.001) and femoral neck BMD trajectories (β = 0.022; 95% CI, 0.005-0.039; P=0.012). Secukinumab was also associated with increased osteocalcin and reduced CTX trajectories, whereas P1NP did not differ significantly. LIMITATIONS: Limitations include the retrospective single-center design, modest sample size, treatment imbalance, surrogate outcomes, and potential residual confounding. CONCLUSION: Compared with adalimumab, secukinumab was associated with more favorable longitudinal BMD trajectories and a bone turnover profile consistent with increased formation and reduced resorption in patients with psoriasis.