{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:54:11Z","timestamp":1790790851618,"version":"4.1.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This real-world study compared the effects of JAK inhibitors (JAKi) versus TNF inhibitors (TNFi) on bone health and survival in rheumatoid arthritis (RA) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the collaborative electronic health records (EHR) database network (2016-2024). After 1:1 propensity score matching, 16, 572 JAKi and 16, 572 TNFi users were included, with follow-up for up to 5 years. Primary outcomes were a composite of \u201cany fracture or osteoporosis, \u201d individual fracture and osteoporosis events, and all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the propensity score\u2013matched cohort, JAKi use was associated with a lower risk of the composite outcome (HR\u00a0=\u00a00.930) and osteoporosis (HR\u00a0=\u00a00.906) compared with TNFi. However, a reduction in fracture risk was not clearly observed. JAKi use was also associated with higher all-cause mortality (HR\u00a0=\u00a01.582). Subgroup estimates suggested potential heterogeneity, but these findings were exploratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large EHR-based cohort, JAKi initiation was associated with lower rates of osteoporosis-related outcomes but higher all-cause mortality compared with TNFi. Given the observational design, potential residual confounding, and limited follow-up for many patients, these findings should be interpreted as associations and warrant confirmation in other datasets and prospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>To compare real-world associations of JAKi vs TNFi with bone outcomes and all-cause mortality in RA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main result<\/jats:title>\n                    <jats:p>In a propensity score\u2013matched cohort, JAKi use was associated with lower osteoporosis-related outcomes but higher all-cause mortality compared with TNFi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>These observational findings suggest a potential trade-off and highlight the need for individualized risk\u2013benefit discussions and confirmation in other datasets\/prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1745048","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:56:50Z","timestamp":1773817010000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Dual effects of JAK vs TNF inhibitors on osteoporosis, fractures and mortality in rheumatoid arthritis: a real-world cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Chunyan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of General Practice, The Second Affiliated Hospital of Fujian Medical University","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daorong","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Ultrasonography, The Second Affiliated Hospital of Fujian Medical University","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Min","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Taitung Hospital, Ministry of Health and Welfare","place":["Taitung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiow-Ing","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Cheng-Chung","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan Graduate Institute of Integrated Medicine, China Medical University","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Second Affiliated Hospital of Fujian Medical University","place":["Quanzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/nature01661","article-title":"Evolving concepts of rheumatoid arthritis","volume":"423","author":"Firestein","year":"2003","journal-title":"Nature"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31472-1","article-title":"Pathogenetic insights from the treatment of rheumatoid 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