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Published on: May 16, 2025
Risk of fracture among patients with rheumatoid arthritis according to serological status: a population-based
Seonghye Kim1, Kyung-Do Han2, Jinhyung Jung3
1Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Abstract:
Patients with rheumatoid arthritis have higher fracture risks than those without RA, particularly in seropositive cases. The risk of fractures remained elevated regardless of bDMARD or tsDMARD use, warranting further large-scale studies. Our findings highlight the need for active surveillance and timely intervention in RA patients, particularly those with SPRA and regardless of bDMARD or tsDMARD use.
Objectives:
Evidence of the association between the serological status and the risk of fracture among patients with rheumatoid arthritis (RA) considering exposure to disease-modifying antirheumatic drugs (DMARDs) is scarce. We investigated the risk of fracture among patients with RA according to the serological status considering exposures to biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs).
Methods:
We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service database including patients who were diagnosed with RA between 2010 and 2017 (n = 43,677) and controls matched according to age and sex (n = 131,031).
Results:
Patients with RA had a higher risk of any fractures compared to matched controls (adjusted hazard ratio [aHR] 1.68, 95% confidence interval [CI] 1.62‒1.75). Patients with seropositive RA (SPRA) had an increased risk of fracture (aHR 1.19, 95% CI 1.11‒1.28 for any fractures; aHR 1.40, 95% CI 1.26‒1.55 for vertebral fractures; aHR 1.55, 95% CI 1.19‒2.02 for hip fractures) compared to those with seronegative RA. Compared to matched controls, RA patients showed higher fracture risk regardless of bDMARDs (exposed: 2.28-fold; unexposed: 1.64-fold) or tsDMARDs (exposed: 1.91-fold; unexposed: 1.68-fold).
Conclusion:
Patients with RA were at higher risk of fractures compared to those without RA, with even higher risk among those with SPRA. The risk of fractures remained elevated regardless of bDMARD or tsDMARD use, warranting further studies to explore the impact of bDMARDs and tsDMARDs on fracture risk in patients with RA.
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