Increased risk of osteoporotic fractures in Swedish patients with rheumatoid arthritis despite early treatment with potent disease-modifying anti-rheumatic drugs: a prospective general population-matched cohort study

Nyhall-Wahlin, B-M; Ajeganova, Sofia; Petersson, Ingemar F; Andersson, Maria

doi:10.1080/03009742.2019.1611918

Cited by 13 publications

(8 citation statements)

References 39 publications

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“…A Swedish study found an increased risk of fragility fractures in RA in both the 1990s and 2000s, despite patients in the 2000s receiving potent pharmacological treatment early in the disease. This study, however, was not focused on vertebral fractures, but on other fragility fractures such as upper arm, hip and other fractures [22]. Similarly, an upward trend in the incidence of hip fracture in Spanish RA patients between 1999 and 2015 was reported, despite a decreasing age-adjusted incidence in the Spanish general population [24,25].…”

Section: Discussionmentioning

confidence: 92%

“…However, not all authors have found this beneficial effect [10]. Recent data referring to the prevalence of fractures are scarce, particularly those referring to vertebral fractures, as most series are focused on non-vertebral fractures [21][22][23]. Notably, Ozen et al in 2019 showed a reduction in the risk of vertebral fracture in RA patients treated with anti-TNFα [13].…”

Section: Discussionmentioning

confidence: 99%

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Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study

et al. 2021

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Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. Introduction There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. Methods We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort.Results Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. Conclusion The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study

et al. 2021

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“…In the US, data show that osteoporotic fractures account for about one-third of RA-related mortality 5 . Fractures increase morbidity and mortality, reduce quality of life, reduce independent functioning of people, especially in old age, and increase economic burden 6 , 17 . Vertebral fracture is one of the most common fractures due to decreased BMD, which causes limitation of activity, disability, kyphosis and decreased pulmonary function 10 , 18 , 19 .…”

Section: Introductionmentioning

confidence: 99%

The prevalence of osteoporosis in rheumatoid arthritis patient: a systematic review and meta-analysis

Moshayedi

Tasorian

Almasi‐Hashiani

2022

Sci Rep

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Osteoporosis (OP) is one of the most commonly known extra-articular complications of rheumatoid arthritis (RA). Since the prevalence of OP is diverse in different studies and there is no general consensus about it, in this systematic review, we aimed to investigate the global prevalence of OP among RA patients. In this review, three databases including Medline via PubMed, Scopus, and Web of Science (Clarivate analytics) were searched by various keywords. After screening of retrieved papers, the related data of included papers were extracted and analyzed. To assess the risk of methodological bias of included studies, quality assessment checklist for prevalence studies was used. Because of heterogeneity among studies, random-effect model was used to pooled the results of primary studies. In this review, the results of 57 studies were summarized and the total included sample size was 227,812 cases of RA with 64,290 cases of OP. The summary point prevalence of OP among RA was estimated as 27.6% (95%CI 23.9–31.3%). Despite significant advances in prevention, treatment and diagnostic methods in these patients, it still seems that the prevalence of OP in these patients is high and requires better and more timely interventions.

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“…Bone loss starts already early in the disease course [ 4 ] and increases with longer disease duration [ 5 ]. The prevalence of bone loss and the risk of osteoporosis-related fragility fractures (both vertebral and non-vertebral) is about double that expected in non-RA populations [ 6 – 8 ]. Despite recent therapeutic advances, the risk of fragility fractures in RA is still increased compared with that in the general population [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term fracture risk in rheumatoid arthritis: impact of early sustained DAS28-remission and restored function, progressive erosive disease, body mass index, autoantibody positivity and glucocorticoids. A cohort study over 10 years

Ajeganova,

Andersson,

Forslind

et al. 2023

BMC Rheumatol

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Background Risk of fragility fractures in patients with rheumatoid arthritis (RA) is increased. Disease-related inflammation in RA is associated with low Bone Mineral Density (BMD). However, effects of specific disease factors on fracture occurrence and whether or not such disease effects are independent of BMD are unknown. Methods Analysis of fracture outcome in the prospective cohort of 2557 patients with early RA (67% women, mean age 58.1 ± 15.6 years) during an observation period of 10.6 ± 4.7 years. In 602 patients BMD was measured at baseline. The first major fragility fractures were considered. Kaplan-Meier and Cox regression analysis, adjusted for traditional factors, prior fracture, disease activity and period of inclusion, were used to estimate the risk of the outcome. Results During follow-up fracture occurred in 352 patients (13.8%), a rate of 13/1000 p-y. A proportional risk reduction for the outcome was associated with Body Mass Index (BMI) at baseline, BMI ≥ 30 kg/m2, and over the first two years sustained Disease Activity Score (DAS28)-remission, DAS28-low disease activity and Health Assessment Questionnaire (HAQ) ≤ 0.5. The proportional risk elevation for fractures was associated with BMI ≤ 20 kg/m2, DAS28 at baseline, 6-month and at 1-year, cumulative DAS28 over the two years, RF, erosion score progression at 2-year, HAQ score and HAQ ≥ 1 at 6-month and 1-year and showed a trend for ACPA positivity. The estimated fracture risk was increased in users of glucocorticoids (GC), associated with a higher GC-dosage at follow-ups and a higher cumulative dosage over two years, independently of disease activity. With adjustment for BMD, there was no difference in fracture outcome by exposure to GC. The effects of a higher BMI, DAS28-remission and low HAQ ≤ 0.5 attained at 6-month of treatment initiation and sustained up to 2 years, RF, ACPA, and erosion score progression at 2-year were independent of low BMD. Conclusions This analysis supports importance of RA-specific risk factors in early RA for future major fragility fractures. Treat-to-target strategy and restored functional capacity in early RA-disease are important to prevent fractures. Autoantibody positivity, progressively erosive disease, and low weight could have additional value for personalized fracture preventive strategies in early RA.

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Increased risk of osteoporotic fractures in Swedish patients with rheumatoid arthritis despite early treatment with potent disease-modifying anti-rheumatic drugs: a prospective general population-matched cohort study

Cited by 13 publications

References 39 publications

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study

The prevalence of osteoporosis in rheumatoid arthritis patient: a systematic review and meta-analysis

Long-term fracture risk in rheumatoid arthritis: impact of early sustained DAS28-remission and restored function, progressive erosive disease, body mass index, autoantibody positivity and glucocorticoids. A cohort study over 10 years

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