# Risk of Fractures and Joint Replacement Surgeries with TNF-inhibitor Use in Ankylosing Spondylitis

> **NIH NIH R03** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2021 · $80,025

## Abstract

PROJECT SUMMARY
Ankylosing spondylitis (AS) is a relatively common form of inflammatory arthritis of the spine that may cause
severe disability and reduced quality of life. In addition to the spine, AS may cause arthritis of other joints, most
commonly the hip and knee, causing the need for joint replacement surgery. Additionally, local and system-
wide inflammation may lead to reduced bone density and fractures even in early disease.
While the primary goal of AS treatment is to control spinal inflammation, an important secondary goal is to
improve overall quality of life, but little data exist to date about whether available treatments have effects on AS
complications that may also affect quality of life. Knowledge about how AS treatments impact disease
complications would inform shared decision-making between AS patients and their healthcare providers. The
goal of this proposal is to estimate the effects of tumor necrosis factor inhibitors (TNFi) on AS complications,
including end-stage arthritis of the hip and knee (joint replacements) and fractures. The proposed work will
translate basic immunology knowledge about the effects of inflammation on bone into population science. This
work will be among the first to assess the effects of TNFi on joint replacement surgeries and fractures, using
data from 3 large databases derived from electronic medical records and billing records, and importantly will
include data specific to the US population. We will use both nested case-control studies and compare trends
in these outcomes between patients with AS in the pre-TNFi and TNFi eras versus the general population to
also understand overall improvements in general medical care. On completion of the proposed studies, we will
have evidence for the effects of TNFi on AS manifestations beyond the effects on spinal inflammation. This
knowledge will inform shared decision-making between AS patients and their healthcare providers in selecting
therapies, and may provide rationale for earlier treatment with TNFi for insurers and other payors.

## Key facts

- **NIH application ID:** 10137893
- **Project number:** 5R03AR076495-02
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Maureen Dubreuil
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $80,025
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10137893

## Citation

> US National Institutes of Health, RePORTER application 10137893, Risk of Fractures and Joint Replacement Surgeries with TNF-inhibitor Use in Ankylosing Spondylitis (5R03AR076495-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10137893. Licensed CC0.

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