TY - JOUR
T1 - Biological disease-modifying antirheumatic drugs and osteoporotic fracture risk in patients with rheumatoid arthritis
T2 - a Danish cohort study
AU - Abtahi, Shahab
AU - Cordtz, René
AU - Dreyer, Lene
AU - Driessen, Johanna H M
AU - Boonen, Annelies
AU - Burden, Andrea M
N1 - Funding Information:
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).
Funding Information:
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).
Publisher Copyright:
© 2022
PY - 2022/7
Y1 - 2022/7
N2 - 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.
AB - 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.
KW - Biological products
KW - Disease-modifying antirheumatic drugs
KW - Osteoporotic fractures
KW - Rheumatoid arthritis
U2 - 10.1016/j.amjmed.2022.01.017
DO - 10.1016/j.amjmed.2022.01.017
M3 - Article
C2 - 35134369
SN - 0002-9343
VL - 135
SP - 879-888.e3
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -