Use of immunosuppressive agents may increased fracture risk among patients with autoimmune diseases

Several studies have investigated the association between immunosuppressive agents and fracture risk in patients with autoimmune diseases. The mechanisms underlying the association between immunosuppressive agents and fracture risk in autoimmune disease patients are complex and not fully understood.

However, it is thought that these medications may affect bone metabolism and increase the risk of osteoporosis, a condition characterized by low bone density and increased fracture risk. A new study in Biomedicines reports that the long-term use of immunosuppressive agents in patients with autoimmune diseases may increase the risk of fractures specifically the hip regions.

Researchers conducted a retrospective study using data from Taiwan’s National Health Insurance Research Database. Patients diagnosed with autoimmune diseases between 2000 and 2014, including psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus, were included in the study. A control group of patients without autoimmune diseases was selected from the same database during the same period. Patients with autoimmune diseases were divided into two sub-cohorts based on their use of immunosuppressive agents.

The key findings of the study are

• This study found the risk of fractures was 1.14 times higher in patients with autoimmune diseases than in those without.

• Moreover, they found that patients in the immunosuppressant sub-cohort had a higher risk of fractures compared to those in the non-immunosuppressant sub-cohort.

• The adjusted sub-distribution hazard ratio for shoulder fractures was 1.27 (95% CI = 1.01–1.58), for spine fractures was 1.43 (95% CI = 1.26–1.62), for wrist fractures was 0.95 (95% CI = 0.75–1.22), and for hip fractures was 1.67 (95% CI = 1.38–2.03).

Researchers concluded that “The results of this study suggest that immunosuppressive use may increase the risk of fractures in patients with autoimmune diseases, particularly at the hip. Clinicians should be aware of this potential risk and take steps to minimize the risk of falls in these patients.” Further research is needed to elucidate the mechanisms underlying the association between immunosuppressant use and fracture risk in autoimmune diseases and to determine the optimal strategies for preventing fractures in these patients.

Reference: Kao F-C, Hsu Y-C, Tu Y-K, Chen T-S, Wang H-H, Lin J. Long-Term Use of Immunosuppressive Agents Increased the Risk of Fractures in Patients with Autoimmune Diseases: An 18-Year Population-Based Cohort Study. Biomedicines. 2023; 11(10):2764. https://doi.org/10.3390/biomedicines11102764.