(65) Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study with Prevalent New-User Design

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 739

Presenting Author(s)

Shahab Abtahi, MD, PhD
– Postdoctoral Researcher, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht University, Utrecht, Utrecht, Netherlands

Co-Author(s)

René Cordtz, MD PhD
– Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark, Denmark
Lene Dreyer, MD PhD
– Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark, Denmark
Johanna H. M. H.M. Driessen, PhD
– Postdoctoral Research Fellow, Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands, Maastricht, Limburg, Netherlands
Annelies Boonen, MD PhD
– Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands, Maastricht, Netherlands
Andrea Burden
– Professor, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland

Background: 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 (RA), however it is unclear if this translates to a reduced fracture risk.

Objectives: We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in patients with RA.

Methods: A cohort of 18+ patients with RA from DANBIO were linked to population-based health registries in Denmark between 2006 and 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. Secondary analyses were performed with stratification by sex and RA disease activity at baseline.

Results: Out of 24,678 patients with RA, 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 RA patients (hazard ratio 0.97, 95% CI 0.78-1.20), compared with no biological treatment. The risk estimates were similar for all osteoporotic fracture sites. There was no effect modification by sex or RA disease activity at baseline.

Conclusions: We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with RA.