Therapy with biological DMARDs shows no correlation with fracture risk in RA

Patients with rheumatoid arthritis (RA) carry an almost 50% higher risk of major osteoporotic fractures (MOF) than patients without RA, according to the Norwegian HUNT study. The highest risk was noted in RA patients that had never used disease-modifying antirheumatic drugs (DMARDs).

Previous studies have shown that the incidence of osteoporosis among patients with RA is 1.9 times higher than among non-RA patients [1]. Although bone-sparing properties for biological (b)DMARDs have been demonstrated, the effect of different types of DMARDs on reducing fracture risk is yet to be explored in detail [2,3].

To answer this question, Ms Ingebjorg Tronstad (Norwegian University of Science and Technology, Norway) performed the Trondelag Health Study (HUNT), a population-based longitudinal study including 96,354 participants who 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 ACR/EULAR criteria [4]. 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 MOF diagnosed were also recorded, as well as the use of DMARDs. Ms Tronstad and her team 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 ever used bDMARDs. Participants were followed up until the first MOF, death, emigration, or end of follow-up in October 2021.

The results 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 individuals treated with bDMARDS had no association with MOF, which should be considered in future treatment regimens for RA patients.

1. Lee SG, et Int J Rheum Dis. 2012;15:289-96.
2. Chen JF, et Rheumatology (Oxford). 2020;59:2471-2480.
3. Shao F, et Eur Rev Med Pharmacol Sci. 2021;25:3416-3424.
4. Tronstad I, et al. Do disease modifying antirheumatic drugs influence the fracture risk in rheumatoid arthritis? The HUNT POS0175, EULAR 2023, 31 May–3 June, Milan, Italy.

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Posted on 31 July, 202327 March, 2024