Osteoporosis, fracture rates in rheumatoid arthritis have fallen significantly since 1996
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Key takeaways:
- Overall, 28.3% of patients with RA treated from 2005 to 2019 had osteoporosis vs. 48.4% of those treated from 1996 to 2004.
- In long-standing RA, bone mineral density was significantly higher in those receiving biologics.
Rates of osteoporosis and osteoporotic fractures have fallen significantly among patients with rheumatoid arthritis over the past 24 years, according to a single-center study published in RMD Open.
“In the last 15 years, many recommendations such as the treat-to-target strategy and the regularly updated recommendations of the European League Against Rheumatism have improved the outcome of RA patients and also addressed bone health,” Peter Oelzner, MD, of Jena University Hospital, in Germany, and colleagues wrote. “In addition, the therapeutic armamentarium for RA has increased substantially over the last 25 years, and it can be expected that the tremendous success in controlling inflammatory arthritis with modern antirheumatic treatment will also decrease RA-associated osteoporosis.”
To evaluate changes in osteoporosis prevalence in RA over a period of 24 years, Oelzner and colleagues analyzed their own center’s data on osteoporosis and osteoporotic fractures among patients with RA from 1996 to 2019. The study included 1,086 patients with RA (mean age, 59.8 years) divided into two groups — an earlier cohort treated between 1996 and 2004 (n = 539), and a later cohort treated between 2005 and 2019 (n = 547).
“The division into both groups was made because after 2004, the therapy of RA in our center had become significantly more effective, especially due to the increasing use of tumor necrosis factor (TNF) inhibitors, and the aims of the therapy had become more ambitious,” Oelzner and colleagues wrote.
The researchers analyzed patients from the time of their first osteological assessment with bone mineral density to the last collection of osteologically important data. Osteoporosis prevalence was compared between the earlier and later cohorts, and factors predicting bone mineral density were assessed using linear regression analysis.
Compared with the earlier cohort, the later cohort demonstrated a significantly lower rate of osteoporosis — 28.3% vs. 48.4% (P < .001) — osteoporotic peripheral fractures — 11.5% vs. 21% (P < .001) — and vertebral fractures — 6.6% vs. 10.9% (P = .011). According to the researchers, the later cohort also saw more frequent treatment with biologic drugs — 19.7% vs. 5% (P < .001) — while treatment with glucocorticoids was significantly less common (P = .005).
Among patients who had RA for longer than 2 years, bone mineral density was significantly higher in those who used biologic treatment (P < .001), even though they had higher cumulative doses of glucocorticoids (P < .001), they added.
“The results of our study have shown a significant reduction of osteoporosis and osteoporotic fractures in RA patients treated between the years 2005 and 2019, compared with those between 1996 and 2004,” Oelzner and colleagues wrote.
“The decrease in the prevalence of osteoporosis is associated with a significantly higher proportion of patients having an osteological assessment within the first 2 years of RA, lower cumulative [glucocorticoid] doses and more frequent use of biologicals in patients with longer disease duration,” they added. “Furthermore, our data suggest a partial antagonisation of negative GC effects on bone by [biologic DMARDs].”
Perspective
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Daniel J. Wallace, MD, FACP, MACR
Patients with rheumatoid arthritis are at an increased risk for osteoporosis and osteoporotic compression fractures. The last 24 years have seen the advent of biologics and oral small molecule therapy, as well as a decrease in the use of corticosteroids. Conventional disease modifying drug use has also decreased.
These environmental changes have led to improvements in the management of RA. More than 1,000 German patients with RA were followed during this period of time and the prevalence of osteoporosis has decreased, as have glucocorticoid therapy and fractures. The use of bisphosphonates has remained the same.
This well written article suggests that biologic therapies and decreased use of steroid therapies are associated with a dramatic decrease in osteoporosis and its associated fractures. This further reinforces the safety of long-term use of biological therapies.
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