In a nutshell
This study analyzed the effect of using biological disease-modifying anti-rheumatic drugs (bDMARDs) on fracture risk in patients with rheumatoid arthritis (RA). The data suggest no evidence that the use of bDMARDs impacts fracture risk in these patients.
RA is a chronic, systemic (affects the whole body) inflammatory disease. Symptoms include pain, multiple joint swellings, osteoporosis (weakened, brittle bones), and fractures (broken bones), among others. Management of symptoms in patients is achieved through the use of medications that reduce inflammation and prevent bone erosions (bone loss). However, some RA medications like steroids can also contribute to the development of osteoporosis and may increase the risk of fracture development.
Other commonly used RA medications are conventional DMARDs (cDMARDs) and bDMARDs. Patients previously but unsuccessfully treated with cDMARDs can show significant improvements in symptoms, function, and remission rates when administered bDMARDs. Unlike cDMARDs, bDMARDs are shown to have a protective effect against bone loss.
Therefore, it is important to assess whether bDMARDs can reduce the risk of fractures in patients with RA, based on existing studies.
Methods & findings
This study reviewed the results of 9 studies that involved a total of 193,160 patients with RA. Patients using bDMARDs varied from 2.4% to 51.2% in these studies. The use of bDMARDs was compared to fracture risk.
There was no statistically significant difference in the risk of fractures in patients with RA using bDMARDs including tumor necrosis factor (TNF) inhibitors, compared to those who did not used bDMARDs.
The bottom line
The authors concluded that based on the current data, there appears to be no impact of bMARDs on fracture risk in patients with RA.
The fine print
The studies included in this review were not randomized, controlled trials. Therefore some selection bias is expected. Some of the studies did not account for important confounders. Wide variations were seen with some study sample sizes. Fracture risk may have been underestimated because of inadequate radiographic screening. The type and duration of bDMARDs were not indicated in many of the studies.
Ask your doctor if you have any questions concerning fracture risks and the use of bDMARDs for RA.
Published By :
European review for medical and pharmacological sciences
May 01, 2021
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