Biological disease-modifying antirheumatic drugs and osteoporotic fracture risk in patients with rheumatoid arthritis: a Danish cohort study

Shahab Abtahi, René Cordtz, Lene Dreyer, Johanna H.M Driessen, Annelies Boonen, Andrea M Burden*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)879-888.e3
JournalThe American Journal of Medicine
Volume135
Issue number7
Early online date5 Feb 2022
DOIs
Publication statusPublished - Jul 2022

Bibliographical note

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

Keywords

  • Biological products
  • Disease-modifying antirheumatic drugs
  • Osteoporotic fractures
  • Rheumatoid arthritis

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