Do bDMARDs prevent osteoporotic fractures in RA patients?

Use of biological disease-modifying antirheumatic drugs (bDMARDs) appears to have no benefit in the prevention of osteoporotic fractures among patients with rheumatoid arthritis (RA), according to the results of a recent study.

RA patients aged ≥18 years from DANBIO were linked to population-based health registries in Denmark (2006‒2016). The investigators adopted a new-user design and matched bDMARD users to bDMARD-naïve patients using time-conditional propensity scores. Finally, they estimated the risk of incident osteoporotic fractures (hip, vertebrae, humerus, and forearm) using Cox proportional hazard models.

Of the 24,678 RA patients identified, 4,265 bDMARD users were matched 1:1 to bDMARD-naïve patients (mean age 56.2 years, 74 percent female).

A total of 229 osteoporotic fractures occurred among bDMARD users (incidence rate, 12.1 per 1,000 person-years) and 205 (incidence rate, 13.0 per 1,000 person-years) among bDMARD-naïve patients during follow-up.

Treatment with bDMARDs did not result in a reduction of osteoporotic fracture risk among RA patients (hazard ratio, 0.97, 95 percent confidence interval, 0.78‒1.20) compared with no biological treatment. The risk estimates were comparable across osteoporotic fracture sites.

“We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with RA,” the investigators said.

Of note, previous studies have demonstrated the benefit of bDMARD treatment on hand or axial bone loss in patients with RA.