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HUNT study: DMARDs influence the fracture risk in RA

Presented by
Dr Ingebjørg Tronstad , Norwegian University of Science and Technology, Norway
Conference
EULAR 2023


In a large population-based study, rheumatoid arthritis (RA) was associated with an almost 50% increased risk of major osteoporotic fractures (MOF) compared with non-RA. However, RA treated with biological disease-modifying antirheumatic drugs (DMARDs) showed no association with MOF.

Compared with the general population, RA patients have reduced bone mineral density and increased fracture risk. Although bone-sparing properties for bDMARDs have been demonstrated, the effect of different types of DMARDs on reducing fracture risk is yet to be explored in detail [1,2].

To answer this question, Dr Ingebjørg Tronstad (Norwegian University of Science and Technology, Norway) performed the Trondelag Health Study (HUNT), a population-based longitudinal study including 96,354 participants that were classified based on whether or not they had RA according to existing patient records or per International Classification of Disease codes (ICD9 and 10) and the American College of Rheumatology/European League Against Rheumatism criteria. Disease status was registered at baseline and updated if RA was diagnosed later. Accordingly, 1,033 patients had RA (mean age 46.3 years, 53% women), and 95,321 did not. Of the former, 401 were diagnosed before inclusion in the study and 632 during follow-up.

Any MOFs diagnosed were also recorded, as well as the use of DMARDs. Dr Tronstad classified patients into 3 groups: 57 patients who had never used DMARDs (never DMARDs), 727 patients using conventional synthetic (cs) DMARDs only, and 230 patients who had never used biological (b) DMARDs. Participants were followed up until the first MOF, death, emigration, or end of follow-up in October 2021.

Dr Tronstad revealed that patients with RA, regardless of treatment, had an almost 50% increased risk of MOF compared with patients without RA (HR 1.44; 95% CI 1.25–1.65). Additionally,  the incidence rates of MOF per 1,000 person-years were higher in RA overall and in all DMARD treatment groups compared with non-RA. After Cox regression analyses adjusted for age, sex, and smoking status, it was found that across the 3 treatment groups, never DMARDs had the highest risk of MOF (HR 2.05; 95% CI 1.28–3.31) followed by the csDMARDs group (HR 1.5; 95% CI 1.29–1.75). In contrast, treatment with bDMARDs did not significantly correlate with MOF (HR 1.03, 95% CI 0.70–1.50).

The authors concluded that even though RA is associated with MOF, it is encouraging that those individuals treated with bDMARDS had no association with MOF, which should be considered in future treatment regimens for RA patients.

  1. Tronstad I, et al. Do disease-modifying antirheumatic drugs influence the fracture risk in rheumatoid arthritis? The HUNT study. POS0175, EULAR 2023, 31 May–3 June, Milan, Italy.

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