Significant decrease of osteoporosis and osteoporotic fractures in rheumatoid arthritis within a period of 24 years: experiences of a single centre

Abstract

Objectives: Rheumatoid arthritis (RA) is associated with an increased risk for osteoporosis and osteoporotic fractures. Since the treatment of RA has improved significantly in recent years, we can expect RA-associated osteoporosis to decrease with good disease control. Therefore, we conducted a retrospective study to investigate whether the frequency of osteoporosis and osteoporotic fractures has changed during 24 years in RA.

Methods: We analysed the data of 1.086 RA patients from the time of the first osteological assessment with bone mineral density (BMD) measurement and collection of osteologically important data during the years 1996 and 2019 at our clinic. According to the treatment period, the patients were divided into cohort 1 (investigation between 1996 and 2004; n=539) and cohort 2 (investigation between 2005 and 2019; n=547). The data of the two cohorts were compared, and predictors of BMD were analysed by linear regression analysis.

Results: Prevalence of osteoporosis (28.3% vs 48.4%; p<0.001) as well as osteoporotic peripheral fractures (11.5% vs 21%; p<0.001) and vertebral fractures (6.6% vs 10.9%; p=0.011) were significantly lower and treatment with biologicals (19.7% vs 5.0%; p<0.001) significantly more common and glucocorticoid use was significantly less common (p=0.005) in cohort 2. In RA patients with a disease duration of more than 2 years, BMD was significantly higher under treatment with biologicals (p<0.001) despite increased cumulative glucocorticoid dosages (p<0.001).

Conclusion: Our study showed a significant decline in osteoporosis and osteoporotic fractures in RA for 24 years. This positive effect is associated with the more frequent use of biologicals in the years between 2005 and 2019.

Keywords: Bone Density; Glucocorticoids; Osteoporosis; Rheumatoid Arthritis.

Figure 1. Prevalence of osteoporosis (OP) in rheumatoid arthritis (RA) patients according to the time period of first osteological diagnosis, including subgroups stratified by glucocorticoid (GC) therapy, gender and menopausal status.

Figure 2. Prevalence of osteoporosis (OP) in rheumatoid arthritis patients according to period of first osteological diagnosis in subgroups stratified by disease duration (A), body mass index (B) and age (C).

Figure 3. The reduction of osteoporosis, peripheral fractures and vertebral fractures based on the use of biologic disease-modifying antirheumatic drugs (bDMARDs) (csDMARD, conventional synthetic disease-modifying antirheumatic drugs). Created with BioRender.com.