Osteoporotic Fractures: Relation to Mortality, Medication Use, and Rheumatoid Arthritis

This dissertation research studied osteoporotic fractures both in the general population and among the patients with rheumatoid arthritis. The thesis shows that there was a recent declining trend in osteoporotic fractures in Denmark. Based on these findings, oral bisphosphonates have no beneficial effect on reducing the number of deaths in patients with an osteoporotic fracture. The research also studied various exposure patterns of oral glucocorticoids in the general population and found out that a threshold of 1 g prednisolone equivalent, as hallmark of long-term glucocorticoid therapy, heralds an increased risk of hip and vertebral fractures among those taking high daily doses of glucocorticoids. Given the widespread use of proton pump inhibitors (antacid medications), especially among elderly, he evaluated concomitant use of oral glucocorticoids and proton pump inhibitors in patients with rheumatoid arthritis and reported an increased risk of osteoporotic fractures with it. According to this dissertation, low-dose oral glucocorticoid therapy incurs a 59% increased risk of vertebral fracture in patients with rheumatoid arthritis, but no increased risk with nonvertebral osteoporotic fractures. And lastly, this research showed that use of biological disease-modifying antirheumatic drugs, as cornerstone of rheumatoid arthritis pharmacotherapy, has no independent beneficial effect on reducing osteoporotic fractures in patients with rheumatoid arthritis.