Analyzing the risk of osteoporosis and fracture in rheumatoid arthritis patients who have been treated with various biologics

Yu Jih Su, Chun Yu Lin, Chung Yuan Hsu

Research output: Contribution to journalArticlepeer-review


Background: Rheumatoid arthritis (RA) is a major risk factor for osteoporosis/osteoporotic fractures. We aimed to elucidate the role of treatment choices among osteoporosis/osteoporotic fractures. Methodology: We utilized the Chang-Gung Research Database to assess the risks of osteoporosis/osteoporotic fractures among independently treated RA patients, using retrospective time-to-event outcomes analysis. Results: A total of 3509 RA patients with a mean of 63.1 ± 8.6 years were analyzed. Among all, 1300 RA patients (37%) were diagnosed with newly diagnosed osteoporosis. The crude incidence of newly diagnosed osteoporosis was the highest among those treated with other conventional disease-modifying anti-rheumatic drugs (cDMARDs; 74.1 events/1000-PYs, 95%CI 66.0–82.3), followed by those with a non-treatment period (68 events/1000-PYs, 95%CI 63.1–72.9), methotrxate (MTX) monotherapy (60.7 events/1000-PYs, 95%CI 41.2–80.3), MTX plus other cDMARDs (51.9 events/1000-PYs, 95%CI 43.4–60.3), and abatacept/rituximab (48.6 events/1000-PYs, 95%CI 14.9–82.3). The lowest crude incidence was found in patients treated with anti-TNFi biologics (40.4 events/1000-PYs, 95%CI 28.6–52.2) and other biologic disease-modifying anti-rheumatic drugs (bDMARDs; 40.1 events/1000-PYs, 95%CI 8.0–72.1). A total of 270 patients (20.8%) suffered from an incident fracture during follow-ups. The crude incidence of fracture was the highest among those treated with abatacept/rituximab (49.0 events/1000-PYs, 95%CI 6.0–91.9), followed by those with non-treatment periods (24.3 events/1000-PYs, 95%CI 19.3–29.4), other cDMARDs (24.2 events/1000-PYs, 95%CI 18.1–30.2), anti-TNFi biologics (20.2 events/1000-PYs, 95%CI 8.8–31.6). Other bDMARDs (13.3 events/1000-PYs, 95%CI 0–39.2), MTX mono (12.5 events/1000-PYs, 95%CI 0.3–24.8), and MTX plus other cDMARDs (11.4 events/1000-PYs, 95%CI 5.4–17.4) were low incidences. Conclusion: The treatment option has emerged as a critical determinant in the context of future osteoporosis and osteoporotic fracture risks among RA. These findings offer a valuable resource for clinicians, empowering them to tailor bespoke treatment strategies for RA patients, thereby mitigating the potential for future osteoporosis and fractures.

Original languageEnglish
Article numbere15055
JournalInternational Journal of Rheumatic Diseases
Issue number2
Publication statusPublished - 2024 Feb

All Science Journal Classification (ASJC) codes

  • Rheumatology


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