Abstract
Objectives
Clinical trials have shown a beneficial effect from biological disease-modifying antirheumatic
drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis;
however, it is unclear if this translates to a reduced fracture risk. We investigated
the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment
in rheumatoid arthritis.
Methods
A cohort of patients with rheumatoid arthritis aged 18+ from DANBIO was linked to
population-based health registries in Denmark (2006-2016). Adopting a prevalent new-user
design, we matched bDMARD users to bDMARD-naïve patients using time-conditional propensity
scores. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus,
and forearm) was estimated among the matched patients by Cox proportional hazards
models.
Results
Out of 24,678 patients with rheumatoid arthritis, 4265 bDMARD users were matched to
the same number of bDMARD-naïve patients (mean age 56.2 years, 74% female). During
follow-up, 229 osteoporotic fractures occurred among bDMARD users and 205 fractures
among bDMARD-naïve patients (incidence rates 12.1 and 13.0 per 1000 person-years,
respectively). The use of bDMARDs was not associated with a reduced risk of osteoporotic
fractures among patients with rheumatoid arthritis (hazard ratio 0.97, 95% confidence
interval 0.78-1.20), compared with no biological treatment. The risk estimates were
similar for all osteoporotic fracture sites.
Conclusion
We found no independent beneficial effect from using bDMARDs on reducing the risk
of osteoporotic fractures in patients with rheumatoid arthritis.
Keywords
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Article Info
Publication History
Published online: February 05, 2022
Footnotes
Funding: None.
Conflicts of Interest: SA, RC, JHMD report none. LD reports receiving grants/research support from BMS, honoraria from Eli Lilly, and support for attending meetings from UCB, Abvie, and Boehringer Engelheim. AB reports receiving research grants from Abbvie and honoraria for advisory boards from Abbvie and Galapagos. AMB is partially endowed by the ETH Foundation and the Swiss National Pharmacists Association (PharmaSuisse).
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Published by Elsevier Inc.
