Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway
Objectives Rheumatoid arthritis has been associated with increased fracture risk. New treatments have improved the course of the disease substantially, but it is not clear if this influences fracture risk. We examined if rheumatoid arthritis, overall and according to disease-modifying antirheumatic...
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BMJ Publishing Group
2024-02-01
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| author | Tom Ivar Lund Nilsen Mari Hoff Vibeke Videm Arnulf Langhammer Jonas Johansson Julie Horn Ingebjørg Tronstad Sigrid Anna Aalberg Vikjord |
| author_facet | Tom Ivar Lund Nilsen Mari Hoff Vibeke Videm Arnulf Langhammer Jonas Johansson Julie Horn Ingebjørg Tronstad Sigrid Anna Aalberg Vikjord |
| author_sort | Tom Ivar Lund Nilsen |
| collection | DOAJ |
| description | Objectives Rheumatoid arthritis has been associated with increased fracture risk. New treatments have improved the course of the disease substantially, but it is not clear if this influences fracture risk. We examined if rheumatoid arthritis, overall and according to disease-modifying antirheumatic drugs (DMARDs), is associated with a risk of major osteoporotic fractures.Methods Overall, 92 285 participants in the population-based Nord-Trndelag Health Study (HUNT), Norway were included and linked with hospital records for a validated rheumatoid arthritis diagnosis (n=605), type of DMARD treatment and fracture diagnosis. Participants were followed up until the first major osteoporotic fracture, death, emigration or end of follow-up. Cox regression was used to estimate HRs for fractures among individuals with rheumatoid arthritis, overall and by DMARD treatment, compared with participants without rheumatoid arthritis.Results A total of 9670 fractures were observed during follow-up, of which 88 were among those with rheumatoid arthritis. Compared with the reference group of participants without rheumatoid arthritis, those with the disease had an HR of fracture of 1.41 (95% CI 1.13 to 1.74). The association was largely similar for users of csDMARDs (HR 1.44; 95% CI 1.15 to 1.81), whereas the association for bDMARD users was weaker and less precise (HR 1.19; 95% CI 0.64 to 2.21).Conclusion Participants with rheumatoid arthritis had a 40% higher risk of fracture than participants without the disease. A similar fracture risk was observed for conventional synthetic DMARD use, whereas there was weak evidence that the use of biological DMARDs may be associated with a somewhat lower fracture risk. |
| format | Article |
| id | doaj-art-f42e76cd503d4a669c86612b1c223cff |
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| issn | 2056-5933 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
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| series | RMD Open |
| spelling | doaj-art-f42e76cd503d4a669c86612b1c223cff2025-08-20T02:12:50ZengBMJ Publishing GroupRMD Open2056-59332024-02-0110110.1136/rmdopen-2023-003919Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, NorwayTom Ivar Lund Nilsen0Mari Hoff1Vibeke Videm2Arnulf Langhammer3Jonas Johansson4Julie Horn5Ingebjørg Tronstad6Sigrid Anna Aalberg Vikjord71 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, NorwayDepartment of Neuromedicine and Movement Science/Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, NorwayDepartment of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Trondheim, Trøndelag, NorwayHUNT Research Center, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, NorwayDepartment of Community Medicine, UiT The Arctic University of Norway, Tromso, NorwayHUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Levanger, Trøndelag, NorwayHUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Levanger, Trøndelag, NorwayHUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Levanger, Trøndelag, NorwayObjectives Rheumatoid arthritis has been associated with increased fracture risk. New treatments have improved the course of the disease substantially, but it is not clear if this influences fracture risk. We examined if rheumatoid arthritis, overall and according to disease-modifying antirheumatic drugs (DMARDs), is associated with a risk of major osteoporotic fractures.Methods Overall, 92 285 participants in the population-based Nord-Trndelag Health Study (HUNT), Norway were included and linked with hospital records for a validated rheumatoid arthritis diagnosis (n=605), type of DMARD treatment and fracture diagnosis. Participants were followed up until the first major osteoporotic fracture, death, emigration or end of follow-up. Cox regression was used to estimate HRs for fractures among individuals with rheumatoid arthritis, overall and by DMARD treatment, compared with participants without rheumatoid arthritis.Results A total of 9670 fractures were observed during follow-up, of which 88 were among those with rheumatoid arthritis. Compared with the reference group of participants without rheumatoid arthritis, those with the disease had an HR of fracture of 1.41 (95% CI 1.13 to 1.74). The association was largely similar for users of csDMARDs (HR 1.44; 95% CI 1.15 to 1.81), whereas the association for bDMARD users was weaker and less precise (HR 1.19; 95% CI 0.64 to 2.21).Conclusion Participants with rheumatoid arthritis had a 40% higher risk of fracture than participants without the disease. A similar fracture risk was observed for conventional synthetic DMARD use, whereas there was weak evidence that the use of biological DMARDs may be associated with a somewhat lower fracture risk.https://rmdopen.bmj.com/content/10/1/e003919.full |
| spellingShingle | Tom Ivar Lund Nilsen Mari Hoff Vibeke Videm Arnulf Langhammer Jonas Johansson Julie Horn Ingebjørg Tronstad Sigrid Anna Aalberg Vikjord Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway RMD Open |
| title | Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway |
| title_full | Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway |
| title_fullStr | Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway |
| title_full_unstemmed | Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway |
| title_short | Rheumatoid arthritis, disease-modifying antirheumatic drugs and risk of major osteoporotic fracture: prospective data from the HUNT Study, Norway |
| title_sort | rheumatoid arthritis disease modifying antirheumatic drugs and risk of major osteoporotic fracture prospective data from the hunt study norway |
| url | https://rmdopen.bmj.com/content/10/1/e003919.full |
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