Increased risk of osteoporotic vertebral fracture in rheumatoid arthritis patients with new-onset cardiovascular diseases: a retrospective nationwide cohort study in Taiwan

Wang, Hong; Chen, W.; Yeo, Kai-Jieh; Huang, Pei-Ming; Chen, D.-Y.; Lan, Joung‐Liang

doi:10.1007/s00198-019-04966-z

Cited by 13 publications

(10 citation statements)

References 38 publications

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“…Despite the high risk of vertebral fractures for RA patients (OR 3.04) [ 7 ], only a few studies evaluated the effect of different treatment regimens on vertebral fracture risk. A population-based retrospective cohort study showed that in RA patients with cardiovascular disease, low-dose corticosteroids (HR 0.57) as well as hydroxychloroquine (HR 0.12) lowered the risk of vertebral fractures [ 101 ]. Another retrospective cohort study, which followed RA patients for two years after the initiation of a TNF-α antagonist, detected a risk reduction of clinical vertebral fractures (HR 0.71, adjusted for baseline glucocorticoid use); the references were users of csDMARDs [ 102 ].…”

Section: Proof Of Concept: Human Pharmacologic Intervention Studiesmentioning

confidence: 99%

Mechanisms of Systemic Osteoporosis in Rheumatoid Arthritis

Pietschmann

Butylina

Kerschan‐Schindl

et al. 2022

IJMS

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Rheumatoid arthritis (RA), an autoimmune disease, is characterized by the presence of symmetric polyarthritis predominantly of the small joints that leads to severe cartilage and bone destruction. Based on animal and human data, the pathophysiology of osteoporosis, a frequent comorbidity in conjunction with RA, was delineated. Autoimmune inflammatory processes, which lead to a systemic upregulation of inflammatory and osteoclastogenic cytokines, the production of autoantibodies, and Th cell senescence with a presumed disability to control the systemic immune system’s and osteoclastogenic status, may play important roles in the pathophysiology of osteoporosis in RA. Consequently, osteoclast activity increases, osteoblast function decreases and bone metabolic and mechanical properties deteriorate. Although a number of disease-modifying drugs to treat joint inflammation are available, data on the ability of these drugs to prevent fragility fractures are limited. Thus, specific treatment of osteoporosis should be considered in patients with RA and an associated increased risk of fragility fractures.

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Section: Proof Of Concept: Human Pharmacologic Intervention Studiesmentioning

confidence: 99%

Mechanisms of Systemic Osteoporosis in Rheumatoid Arthritis

Pietschmann

Butylina

Kerschan‐Schindl

et al. 2022

IJMS

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“…During the last three decades, many studies have shown that besides the joint inflammation and destruction, bone mass in patients with rheumatoid arthritis (RA) is lower than in the matched non-RA population [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ] and the risk of osteoporosis is increased [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Similarly, the incidence of osteoporotic fractures is high [ 6 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] even when compared to the general population of the same age and sex [ 5 , 9 , 15 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Osteoporosis-related fragility fractures represent one of the most severe complications in RA patien...…”

Section: Introductionmentioning

confidence: 99%

Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

Fardellone

Salawati

Monnier

et al. 2020

JCM

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Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients.

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“…In conclusion, the clinical message should be that osteoporosis medications have a very good safety record and that there is a clear research need to study the potential CV benefits that may, perhaps surprisingly, accompany restoration of bone health (71,87,88) . (9) Total hip BMD predicted incident heart failure in black and non-black men → HR=0.66 [0.51 to 0.85] (10) Incident CV disease increased the risk of vertebral fractures compared to disease free → HR = 1.47 [1.19 to 1.81] (11) Adapted from (5) (57) Alendronate 1/593 (0.1%) 0/586 (0.0%) n/e Myocardial infarction FREEDOM (30) Placebo (54) Meta-analysis vs. Placebo 2/1305 (0.1%) 3/1312 (0.2%) 0.67 [0.11 to 4.00]…”

Section: Conclusion and Research Agendamentioning

confidence: 99%

Cardiovascular Safety of Antifracture Medications in Patients With Osteoporosis: A Narrative Review of Evidence From Randomized Studies

Rodríguez

Abrahamsen

2021

JBMR Plus

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Osteoporosis and cardiovascular (CV) disease share common risk factors and pathophysiology. Low bone mineral density (BMD) and fractures appear to increase the risk for multiple CV diseases. Equally, prevalent CV disease appears to predispose to bone loss and increase fracture rates. This relationship has naturally provoked the hypothesis that stopping bone loss may result in some CV benefit. Secondary analyses of safety and adverse event data from many randomized controlled trials (RCTs) have attempted to clarify this putative association. Recently, the discontinuation of odanacatib (anti‐cathepsin K monoclonal antibody) over stroke concerns and the imbalance in ischemic events in romosozumab‐treated (anti‐sclerostin monoclonal antibody) women compared to bisphosphonate‐treated women, has provided further justification to better characterize potential CV benefits and harms of osteoporosis medications. This review delves into the seminal, and other major RCTs of osteoporosis medications and, using both published data and additional information provided on trial registration pages, examines the evidence for CV safety and harms of these medications. Accepted and emerging “off‐target” effects are explored for validity, biological plausibility, and clinical importance. A brief research agenda is provided to stimulate the next wave of clinical development and CV understanding of osteoporosis medications. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Increased risk of osteoporotic vertebral fracture in rheumatoid arthritis patients with new-onset cardiovascular diseases: a retrospective nationwide cohort study in Taiwan

Cited by 13 publications

References 38 publications

Mechanisms of Systemic Osteoporosis in Rheumatoid Arthritis

Mechanisms of Systemic Osteoporosis in Rheumatoid Arthritis

Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

Cardiovascular Safety of Antifracture Medications in Patients With Osteoporosis: A Narrative Review of Evidence From Randomized Studies

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