{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:43:35Z","timestamp":1792622615705,"version":"4.5.0"},"reference-count":50,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T00:00:00Z","timestamp":1372636800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We tested the hypothesis that initiation of tumor necrosis factor \u03b1 (TNF\u03b1) antagonists reduced the risk of fractures compared to nonbiologic comparators in patients with autoimmune diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using 4 large administrative databases, we assembled retrospective cohorts of patients with autoimmune diseases who initiated either a TNF\u03b1 antagonist or a nonbiologic medication. We identified 3 mutually exclusive disease groups: rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and a combined group: psoriasis (PsO), psoriatic arthritis (PsA), or ankylosing spondylitis (AS). We used baseline covariate data to calculate propensity scores (PS) for each disease group and used Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). We compared the risk of combined hip, radius\/ulna, humerus, or pelvic fractures between PS\u2010matched cohorts of new users of TNF\u03b1 antagonists and nonbiologic comparators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 9,020, 2,014, and 2,663 new PS\u2010matched episodes of TNF\u03b1 antagonist and nonbiologic comparator use in RA, IBD, and PsO\u2010PsA\u2010AS cohorts, respectively. The risk of combined fractures was similar between new users of TNF\u03b1 antagonists and nonbiologic comparators for each disease (HR 1.17, 95% CI 0.91\u20131.51; HR 1.49, 95% CI 0.72\u20133.11; and HR 0.92, 95% CI 0.47\u20131.82 for RA, IBD, and PsO\u2010PsA\u2010AS, respectively). In RA, the risk of combined fractures was associated with an average daily dosage of prednisone equivalents &gt;10 mg\/day at baseline compared with no glucocorticoid (HR 1.54, 95% CI 1.03\u20132.30).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The risk of fractures did not differ between initiators of a biologic agent and a nonbiologic comparator for any disease studied. Among RA patients, use of &gt;10 mg\/day of prednisone equivalents at baseline increased the fracture risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.21937","type":"journal-article","created":{"date-parts":[[2012,12,22]],"date-time":"2012-12-22T01:15:26Z","timestamp":1356138926000},"page":"1085-1094","source":"Crossref","is-referenced-by-count":43,"title":["Initiation of Tumor Necrosis Factor \u03b1 Antagonists and Risk of Fractures in Patients With Selected Rheumatic and Autoimmune Diseases"],"prefix":"10.1002","volume":"65","author":[{"given":"Vivian K.","family":"Kawai","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos G.","family":"Grijalva","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick G.","family":"Arbogast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Curtis","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Delzell","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Ouellet\u2010Hellstrom","sequence":"additional","affiliation":[{"name":"Food and Drug Administration Silver Spring Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Herrinton","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyan","family":"Liu","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Northern California Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Edward F.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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