Session Information
Session Type: ACR/ARHP Combined Abstract Session
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with autoimmune diseases are associated with an increased risk of osteoporotic fracture. Anti-osteoporotic treatment could diminish re-fracture rates in post-menopause women. However, treatment failure of anti-osteoporotic medication in patients with autoimmune diseases remained unknown. The aim of study is to investigate the outcome of anti-osteoporotic treatment in patients with autoimmune rheumatic diseases.
Methods: We conducted a retrospective case-control study analyzing hospital database of a tertiary referral center in Taiwan. From January, 2002 to December 2016, subjects with osteoporotic fracture and anti-osteoporotic treatment were enrolled. Diagnosis of rheumatoid arthritis, systemic lupus erythematosus and primary Sjogren¡¦s syndrome were identified using ICD-9-CM and ICD-10-CM codes. Cases with re-fracture were compared with age-, gender-matched controls (1:4) without re-fracture. Re-fracture incidences were compared among anti-osteoporotic drugs and autoimmune diseases.
Results: In total, 9,384 fracture patients with anti-osteoporotic drugs were indentified; 1,829 patients with autoimmune diseases. Patients receiving teriparatide were older and had lower bone density compared with those receiving bisphosphonates, raloxifene and denosumab, respectively. Participants with previous hip fractures had higher chance of re-fracture compared with their counterparts of previous spine fractures or other fractures. Patients with autoimmune diseases were at higher risk of recurrent fractures (19.3% vs. 10.6%, p<0.001). Moreover, bisphosphonates-treated patients also had higher re-fracture rates compared with those treated with raloxifene, denosumab and teriparatide.
Conclusion: Our results indicated that rheumatic patients were at increased risk of treatment failure in osteoporosis. Adherence of anti-osteoporotic drugs and fall prevention are essential to prevent re-fracture in patients with autoimmune diseases.
Table 1. Demographic data and baseline bone mineral density in patients receiving anti-osteoporotic treatment
|
Bisphosphonate (n=5853) |
Teriparatide (n=916) |
Denosumab (n=1058) |
Raloxifene (n=1557) |
Total (n=9384) |
p value |
|
||||||
|
¡@ |
n |
% |
n |
% |
n |
% |
n |
% |
n |
% |
|
|
|
Age |
72.0 |
¡Ó11.2 |
76.4 |
¡Ó9.5 |
73.3 |
¡Ó10.5 |
71.0 |
¡Ó10.3 |
72.4 |
¡Ó10.9 |
<0.001** |
|
|
Gender |
<0.001** |
|
||||||||||
|
Female |
4260 |
(72.8%) |
760 |
(83.0%) |
902 |
(85.3%) |
1554 |
(99.8%) |
7476 |
(79.7%) |
|
|
|
Male |
1593 |
(27.2%) |
156 |
(17.0%) |
156 |
(14.7%) |
3 |
(0.2%) |
1908 |
(20.3%) |
|
|
|
First fracture |
<0.001** |
|
||||||||||
|
Osteoporotic fracture |
2560 |
(43.7%) |
226 |
(24.7%) |
347 |
(32.8%) |
711 |
(45.7%) |
3844 |
(41.0%) |
|
|
|
Spine fracture |
2555 |
(43.7%) |
603 |
(65.8%) |
513 |
(48.5%) |
644 |
(41.4%) |
4315 |
(46.0%) |
|
|
|
Hip fracture |
510 |
(8.7%) |
63 |
(6.9%) |
120 |
(11.3%) |
140 |
(9.0%) |
833 |
(8.9%) |
|
|
|
Others |
228 |
(3.9%) |
24 |
(2.6%) |
78 |
(7.4%) |
62 |
(4.0%) |
392 |
(4.2%) |
|
|
|
RA |
445 |
(7.6%) |
40 |
(4.4%) |
52 |
(4.9%) |
60 |
(3.9%) |
597 |
(6.4%) |
<0.001** |
|
|
SLE |
309 |
(5.3%) |
31 |
(3.4%) |
31 |
(2.9%) |
44 |
(2.8%) |
415 |
(4.4%) |
<0.001** |
|
|
pSS |
615 |
(10.5%) |
56 |
(6.1%) |
63 |
(6.0%) |
83 |
(5.3%) |
817 |
(8.7%) |
<0.001** |
|
|
Subspecialties |
<0.001** |
|
||||||||||
|
Orthopedics |
2972 |
(50.8%) |
416 |
(45.4%) |
564 |
(53.3%) |
1022 |
(65.6%) |
4974 |
(53.0%) |
|
|
|
Neurosurgery |
1275 |
(21.8%) |
367 |
(40.1%) |
200 |
(18.9%) |
308 |
(19.8%) |
2150 |
(22.9%) |
|
|
|
Rheumatology |
862 |
(14.7%) |
90 |
(9.8%) |
106 |
(10.0%) |
85 |
(5.5%) |
1143 |
(12.2%) |
|
|
|
Others |
744 |
(12.7%) |
43 |
(4.7%) |
188 |
(17.8%) |
142 |
(9.1%) |
1117 |
(11.9%) |
|
|
|
Baseline |
|
|||||||||||
|
Femoral neck BMD (g/cm2) |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
<0.001** |
|
|
Lumbar spine BMD (g/cm2) |
0.9 |
¡Ó0.2 |
0.8 |
¡Ó0.2 |
0.9 |
¡Ó0.2 |
0.8 |
¡Ó0.2 |
0.9 |
¡Ó0.2 |
<0.001** |
|
|
T-score |
-2.8 |
¡Ó0.9 |
-3.4 |
¡Ó0.9 |
-2.8 |
¡Ó0.8 |
-2.8 |
¡Ó0.9 |
-2.9 |
¡Ó0.9 |
<0.001** |
|
|
Chi-Square test. Kruskal Wallis test.*p<0.05, **p<0.01.
|
||||||||||||
|
Continuous data were expressed mean¡ÓSD.
|
||||||||||||
|
Categorical data were expressed number and percentage. |
||||||||||||
Table 2. Comparisons of demographic data, concomitant autoimmune diseases and anti-osteoporotic treatment in patients with and without re-fracture
|
¡@ |
Without re-fracture (n=3256) |
With re-fracture (n=814) |
Total (n=4070) |
p value |
|
|||||||
|
Age |
74.1 |
¡Ó10.0 |
73.7 |
¡Ó10.2 |
74.0 |
¡Ó10.0 |
0.628 |
|||||
|
Gender |
1.000 |
|||||||||||
|
Female |
2564 |
(78.7%) |
641 |
(78.7%) |
3205 |
(78.7%) |
||||||
|
Male |
692 |
(21.3%) |
173 |
(21.3%) |
865 |
(21.3%) |
||||||
|
First fracture |
0.008** |
|||||||||||
|
Osteoporotic fracture |
1466 |
(45.0%) |
386 |
(47.4%) |
1852 |
(45.5%) |
||||||
|
Spine fracture |
1348 |
(41.4%) |
290 |
(35.6%) |
1638 |
(40.2%) |
||||||
|
Hip fracture |
284 |
(8.7%) |
92 |
(11.3%) |
376 |
(9.2%) |
||||||
|
Others |
158 |
(4.9%) |
46 |
(5.7%) |
204 |
(5.0%) |
||||||
|
Autoimmune disease |
345 |
(10.6%) |
157 |
(19.3%) |
502 |
(12.3%) |
<0.001** |
|||||
|
RA |
194 |
(6.0%) |
102 |
(12.5%) |
296 |
(7.3%) |
<0.001** |
|||||
|
SLE |
123 |
(3.8%) |
78 |
(9.6%) |
201 |
(4.9%) |
<0.001** |
|||||
|
pSS |
274 |
(8.4%) |
124 |
(15.2%) |
398 |
(9.8%) |
<0.001** |
|||||
|
Anti-osteoporotic treatment |
<0.001** |
|||||||||||
|
Bisphosphonate |
2045 |
(62.8%) |
578 |
(71.0%) |
2623 |
(64.4%) |
||||||
|
Teriparatide |
305 |
(9.4%) |
47 |
(5.8%) |
352 |
(8.6%) |
||||||
|
Denosumab |
385 |
(11.8%) |
46 |
(5.7%) |
431 |
(10.6%) |
||||||
|
Raloxifene |
521 |
(16.0%) |
143 |
(17.6%) |
664 |
(16.3%) |
||||||
|
Subspecialties |
0.001** |
|||||||||||
|
Orthopedics |
1803 |
(55.4%) |
431 |
(52.9%) |
2234 |
(54.9%) |
||||||
|
Neurosurgery |
650 |
(20.0%) |
141 |
(17.3%) |
791 |
(19.4%) |
||||||
|
Rheumatology |
384 |
(11.8%) |
139 |
(17.1%) |
523 |
(12.9%) |
||||||
|
Others |
419 |
(12.9%) |
103 |
(12.7%) |
522 |
(12.8%) |
||||||
|
Baseline lab data |
||||||||||||
|
Creatinine |
1.1 |
¡Ó0.8 |
1.1 |
¡Ó0.9 |
1.1 |
¡Ó0.9 |
0.008** |
|||||
|
ALT |
23.5 |
¡Ó26.3 |
24.1 |
¡Ó22.9 |
23.6 |
¡Ó25.7 |
0.083 |
|||||
|
Hgb (n=2536) |
12.1 |
¡Ó1.7 |
11.9 |
¡Ó1.9 |
12.1 |
¡Ó1.7 |
0.006** |
|||||
|
Femoral neck BMD (g/cm2) |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
0.6 |
¡Ó0.1 |
0.017* |
|||||
|
Lumbar spine BMD (g/cm2) |
0.9 |
¡Ó0.2 |
0.9 |
¡Ó0.2 |
0.9 |
¡Ó0.2 |
0.438 |
|||||
|
T-score |
-2.8 |
¡Ó0.9 |
-2.9 |
¡Ó1.0 |
-2.8 |
¡Ó0.9 |
0.227 |
|||||
|
Chi-Square test. Kruskal Wallis test. *p<0.05, **p<0.01.
|
|
|||||||||||
|
Continuous data were expressed mean¡ÓSD.
|
|
|||||||||||
|
Categorical data were expressed number and percentage. |
|
|||||||||||
To cite this abstract in AMA style:
Huang WN, Chen YM, Hung WT, Liao YW, Chen YH. The Disproportionate High Risk of Re-Fracture after Osteoporotic Treatment in Patients with Autoimmune Diseases [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-disproportionate-high-risk-of-re-fracture-after-osteoporotic-treatment-in-patients-with-autoimmune-diseases/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-disproportionate-high-risk-of-re-fracture-after-osteoporotic-treatment-in-patients-with-autoimmune-diseases/