Spondyloarthritis & psoriatic arthritis
Comparative Risk of Osteoporosis and Osteoporotic Fractures According to Exposure to 2 Groups of Biologics in Patients With Radiographic Axial Spondyloarthritis
Authors' conclusion
Exposure to TNFi and IL-17i may be associated with a lower risk of osteoporosis, but not hip fracture, compared with the bDMARD-naïve group. Exposure to TNFi, but not IL-17i, may be associated with a lower risk of vertebral fracture compared with the bDMARD-naïve group.
Study context
- Population
- Patients with radiographic axial spondyloarthritis (r-axSpA), nationwide; follow-up from r-axSpA diagnosis to December 2021
- Participants
- 37,708 patients
- Exposure
- Tumor necrosis factor inhibitor (TNFi) vs biologic disease-modifying antirheumatic drug (bDMARD)-naïve, IL-17i vs bDMARD-naïve, and IL-17i vs TNFi
- Outcome
- Osteoporosis, vertebral fracture and hip fracture, defined by diagnosis codes
Methodological detailsnationwide, multivariable time-varying Cox regression, line of bDMARD treatment matched 4:1 (TNFi vs IL-17i)
- Nationwide
- Multivariable time-varying Cox regression
- Line of bDMARD treatment matched 4:1 (TNFi vs IL-17i)
Main finding
As reported in the abstract
Osteoporosis
Adjusted hazard ratio (95% CI)P value
TNFivs bDMARD-naïve
0.83(0.76–0.90)
P < 0.01IL-17ivs bDMARD-naïve
0.19(0.10–0.38)
P < 0.01IL-17ivs TNFiline of bDMARD treatment matched 4:1
0.23(0.11–0.46)
P < 0.01Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Vertebral fractureTNFivs bDMARD-naïve | 0.64 (0.59–0.70) | P < 0.01 | |
| Vertebral fractureIL-17ivs bDMARD-naïveDid not reach statistical significance | 0.52 (0.25–1.09) | P = 0.09 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Hip fracture
- Hip fracture risk did not differ across groups
Original publication
Comparative Risk of Osteoporosis and Osteoporotic Fractures According to Exposure to 2 Groups of Biologics in Patients With Radiographic Axial Spondyloarthritis. J Rheumatol. Published 1 March 2026. doi:10.
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