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

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.