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Antirheumatic Drugs Impact Factor | Open Access Journals
Veterinary Science & Technology

Veterinary Science & Technology

ISSN: 2157-7579

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Antirheumatic Drugs Impact Factor

Several previous studies demonstrate an improvement in bone mineral density associated with the use of tumor necrosis factor (TNFi) inhibitors. We compared the risk of osteoporotic fractures in patients with rheumatoid arthritis (RA) initiating a disease-modifying anti-rheumatic drug (DMARD). A population-based cohort study was conducted using health care use data (1996-2008) from a Canadian province and a US commercial insurance plan. Patients with at least two RA diagnoses were identified, and follow-up began with the first prescription for an DMARD. The treatment regimens were classified into three mutually exclusive hierarchical groups:  TNFi with or without non-biological DMARD (nbDMARD),  methotrexate (MTX) without TNFi, or  other nbDMARD without TNFi or MTX. The main results were hospitalizations for hip, wrist, humerus or pelvis fractures based on diagnoses and procedure codes. The study cohort included 16,412 RA patients with 25,988 new treatment episodes: 5,856 TNFi, 12,554 MTX and 7,578 other nbDMARDs. The incidence rate per 1,000 person-years for osteoporotic fractures was 5.11 [95% confidence interval (CI) 3.50-7.45] for TNFi, 5.35 (95% CI 4 , 08-7.02) for MTX and 6.38 (95% CI 3.78-10.77) for other nbDMARDs. After multivariable adjustment for osteoporosis and risk factors related to fractures, the risk of non-vertebral osteoporotic fracture was not different in TNFi [hazard ratio (HR) 1.07, 95% CI 0.57-1.98 ] or MTX (HR 1.18, 95% CI 0.60-2.34) compared to nbDMARD. Among subjects diagnosed with RA, the adjusted risk of non-vertebral fracture was similar in people starting TNFi, MTX or other nbDMARD.

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