{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T23:20:14Z","timestamp":1783725614977,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["R03\u2010AR\u2010076495"],"award-info":[{"award-number":["R03\u2010AR\u2010076495"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020853","name":"Spondyloarthritis Research and Treatment Network","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020853","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006260","name":"Rheumatology Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006260","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["870726"],"award-info":[{"award-number":["870726"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>There is an increased risk of fracture in individuals with ankylosing spondylitis (AS) compared to the general population, possibly due to systemic inflammatory effects. The use of tumor necrosis factor inhibitors (TNFi) may reduce fracture risk by inhibiting inflammation. We assessed fracture rates in AS versus non\u2010AS comparators and whether these rates have changed since the introduction of TNFi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the national Veterans Affairs database to identify adults \u226518\u2009years old with \u22651 International Classification of Diseases, Ninth Revision (ICD\u20109)\/ICD\u201010 code for AS and at least 1 disease\u2010modifying antirheumatic drug prescription. As comparators, we selected a random sample of adults without AS diagnosis codes. We calculated fracture incidence rates for AS and comparators, with direct standardization to the cohort structure in 2017. To compare fracture rates from 2000 to 2002 (pre\u2010TNFi) versus 2004\u20132020 (TNFi era), we performed an interrupted time series analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 3,794 individuals with AS (mean age 53\u2009years, 92% male) and 1,152,805 comparators (mean age 60\u2009years, 89% male). For AS, the incidence rate of fractures increased from 7.9\/1,000 person\u2010years in 2000 to 21.6\/1,000 person\u2010years in 2020. The rate also increased among comparators, although the ratio of fracture rates (AS\/comparators) remained relatively stable. In the interrupted time series, the fracture rate for AS patients in the TNFi era was nonsignificantly increased compared to the pre\u2010TNFi era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fracture rates have increased over time for both AS and non\u2010AS comparators. The fracture rate in individuals with AS did not decrease after TNFi introduction in 2003.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.25166","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T22:39:50Z","timestamp":1686609590000},"page":"2481-2488","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Trends in Fracture Rates Over Two Decades Among Veterans With Ankylosing Spondylitis"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5440-0961","authenticated-orcid":false,"given":"Sali","family":"Merjanah","sequence":"first","affiliation":[{"name":"Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8104-2450","authenticated-orcid":false,"given":"Jean W.","family":"Liew","sequence":"additional","affiliation":[{"name":"Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Bihn","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanael R.","family":"Fillmore","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary T.","family":"Brophy","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System and Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhan V.","family":"Do","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System and Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6253-1515","authenticated-orcid":false,"given":"Maureen","family":"Dubreuil","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System and Boston University Chobanian and Avedisian School of Medicine  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,22]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-208174"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23468"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.181415"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-017-0274-3"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-018-4086-2"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22934"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e3283620777"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3370"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2014.10.008"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2014.00048"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key001"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2017.1416161"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.05.008"},{"key":"e_1_2_5_15_1","unstructured":"United States Department of Veterans Affairs.National Center for Veterans Analysis and Statistics: quick facts.2021. 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