Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX

John A. Kanis; Helena Johansson; Eugene V. McCloskey; Enwu Liu; Marian Schini; Liesbeth Vandenput; Kristina E. Åkesson; Fred A. Anderson; Rafael Azagra; Cecilie L. Bager; Charlotte Beaudart; Heike A. Bischoff-Ferrari; Emmanuel Biver; Olivier Bruyère; Jane A. Cauley; Jacqueline R. Center; Roland Chapurlat; Claus Christiansen; Cyrus Cooper; Carolyn J. Crandall; Steven R. Cummings; José A.P. da Silva; Bess Dawson-Hughes; Adolfo Diez-Perez; Alyssa B. Dufour; John A. Eisman; Petra J.M. Elders; Serge Ferrari; Yuki Fujita; Saeko Fujiwara; Claus Christian Glüer; Inbal Goldshtein; David Goltzman; Vilmundur Gudnason; Jill Hall; Didier Hans; Mari Hoff; Rosemary J. Hollick; Martijn Huisman; Masayuki Iki; Sophia Ish-Shalom; Graeme Jones; Magnus K. Karlsson; Sundeep Khosla; Douglas P. Kiel; Woon Puay Koh; Fjorda Koromani; Mark A. Kotowicz; Heikki Kröger; Timothy Kwok; Olivier Lamy; Arnulf Langhammer; Bagher Larijani; Kurt Lippuner; Fiona E.A. McGuigan; Dan Mellström; Thomas Merlijn; Tuan V. Nguyen; Anna Nordström; Peter Nordström; Terence W. O´Neill; Barbara Obermayer-Pietsch; Claes Ohlsson; Eric S. Orwoll; Julie A. Pasco; Fernando Rivadeneira; Anne Marie Schott; Eric J. Shiroma; Kristin Siggeirsdottir; Eleanor M. Simonsick; Elisabeth Sornay-Rendu; Reijo Sund; Karin Swart; Pawel Szulc; Junko Tamaki; David J. Torgerson; Natasja M. van Schoor; Tjeerd P. van Staa; Joan Vila; Nicole C. Wright; Noriko Yoshimura; M. Carola Zillikens; Marta Zwart; Nicholas C. Harvey; Mattias Lorentzon; William D. Leslie

doi:10.1007/s00198-025-07397-1

Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX

John A. Kanis^* (Corresponding Author), Helena Johansson, Eugene V. McCloskey, Enwu Liu, Marian Schini, Liesbeth Vandenput, Kristina E. Åkesson, Fred A. Anderson, Rafael Azagra, Cecilie L. Bager, Charlotte Beaudart, Heike A. Bischoff-Ferrari, Emmanuel Biver, Olivier Bruyère, Jane A. Cauley, Jacqueline R. Center, Roland Chapurlat, Claus Christiansen, Cyrus Cooper, Carolyn J. CrandallSteven R. Cummings, José A.P. da Silva, Bess Dawson-Hughes, Adolfo Diez-Perez, Alyssa B. Dufour, John A. Eisman, Petra J.M. Elders, Serge Ferrari, Yuki Fujita, Saeko Fujiwara, Claus Christian Glüer, Inbal Goldshtein, David Goltzman, Vilmundur Gudnason, Jill Hall, Didier Hans, Mari Hoff, Rosemary J. Hollick, Martijn Huisman, Masayuki Iki, Sophia Ish-Shalom, Graeme Jones, Magnus K. Karlsson, Sundeep Khosla, Douglas P. Kiel, Woon Puay Koh, Fjorda Koromani, Mark A. Kotowicz, Heikki Kröger, Timothy Kwok, Olivier Lamy, Arnulf Langhammer, Bagher Larijani, Kurt Lippuner, Fiona E.A. McGuigan, Dan Mellström, Thomas Merlijn, Tuan V. Nguyen, Anna Nordström, Peter Nordström, Terence W. O´Neill, Barbara Obermayer-Pietsch, Claes Ohlsson, Eric S. Orwoll, Julie A. Pasco, Fernando Rivadeneira, Anne Marie Schott, Eric J. Shiroma, Kristin Siggeirsdottir, Eleanor M. Simonsick, Elisabeth Sornay-Rendu, Reijo Sund, Karin Swart, Pawel Szulc, Junko Tamaki, David J. Torgerson, Natasja M. van Schoor, Tjeerd P. van Staa, Joan Vila, Nicole C. Wright, Noriko Yoshimura, M. Carola Zillikens, Marta Zwart, Nicholas C. Harvey, Mattias Lorentzon, William D. Leslie

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Summary: The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. Methods: The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35–1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85–2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis. Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

Original language	English
Pages (from-to)	653-671
Number of pages	19
Journal	Osteoporosis International
Volume	36
Early online date	16 Feb 2025
DOIs	https://doi.org/10.1007/s00198-025-07397-1
Publication status	Published - Apr 2025

Data Availability Statement

We are grateful to Dr. Östen Ljunggren for contributing to the MrOS Sweden cohort. UK Biobank data are included under approved access agreement 3593. The authors acknowledge the Manitoba Centre for Health Policy for use of Manitoba data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred.

Funding

NC Harvey acknowledges funding from the UK Medical Research Council [MC_PC_21003; MC_PC_21001] and the NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005. Funding for the MrOS USA study comes from the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. Funding for the SOF study comes from the National Institute on Aging (NIA), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), supported by grants (AG05407, AR35582, AG05394, AR35584, and AR35583). Funding for the Health ABC study was from the Intramural research program at the National Institute on Aging under the following contract numbers: NO1-AG-6–2101, NO1-AG-6–2103, and NO1-AG-6–2106. The Longitudinal Aging Study Amsterdam is supported by a grant from the Netherlands Ministry of Health, Welfare and Sport, Directorate of Long-Term Care. Funding for the Framingham Study comes from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) R01 AR041398 and AR061445 and the National Heart, Lung, and Blood Institute Framingham Heart Study (N01-HC-25195, HHSN268201500001I). Funding for the GOS was from the Victorian Health Promotion Foundation: ID 91–0095. The SUPERB study was funded with grants from the Swedish Research Council, the IngaBritt and Arne Lundberg Research Foundation, and ALF-grants from the Sahlgrenska University Hospital, Gothenburg, Sweden.

Funders	Funder number
Medical Research Council	MC_PC_21003, MC_PC_21001
National Institutes of Health	75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, 75N92021D00005, U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, AG042143, U01 AG042145, U01 AG042168, U01 AR066160, TR000128, AG05407, AR35582, AG05394, AR35584, AR35583, R01 AR041398, AR061445, N01-HC-25195, HHSN268201500001I, NO1-AG-6–2101, NO1-AG-6–2103, NO1-AG-6–2106
Victorian Health Promotion Foundation	ID 91–0095

Keywords

epidemiology
fracture risk
FRAX
glucocorticoids
hip fracture
major osteoporotic fracture
meta-analysis
osteoporosis
rheumatoid arthritis
risk factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Kanis, J. A., Johansson, H., McCloskey, E. V., Liu, E., Schini, M., Vandenput, L., Åkesson, K. E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., ... Leslie, W. D. (2025). Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX. Osteoporosis International, 36, 653-671. https://doi.org/10.1007/s00198-025-07397-1

Kanis, JA, Johansson, H, McCloskey, EV, Liu, E, Schini, M, Vandenput, L, Åkesson, KE, Anderson, FA, Azagra, R, Bager, CL, Beaudart, C, Bischoff-Ferrari, HA, Biver, E, Bruyère, O, Cauley, JA, Center, JR, Chapurlat, R, Christiansen, C, Cooper, C, Crandall, CJ, Cummings, SR, da Silva, JAP, Dawson-Hughes, B, Diez-Perez, A, Dufour, AB, Eisman, JA, Elders, PJM, Ferrari, S, Fujita, Y, Fujiwara, S, Glüer, CC, Goldshtein, I, Goltzman, D, Gudnason, V, Hall, J, Hans, D, Hoff, M, Hollick, RJ, Huisman, M, Iki, M, Ish-Shalom, S, Jones, G, Karlsson, MK, Khosla, S, Kiel, DP, Koh, WP, Koromani, F, Kotowicz, MA, Kröger, H, Kwok, T, Lamy, O, Langhammer, A, Larijani, B, Lippuner, K, McGuigan, FEA, Mellström, D, Merlijn, T, Nguyen, TV, Nordström, A, Nordström, P, O´Neill, TW, Obermayer-Pietsch, B, Ohlsson, C, Orwoll, ES, Pasco, JA, Rivadeneira, F, Schott, AM, Shiroma, EJ, Siggeirsdottir, K, Simonsick, EM, Sornay-Rendu, E, Sund, R, Swart, K, Szulc, P, Tamaki, J, Torgerson, DJ, van Schoor, NM, van Staa, TP, Vila, J, Wright, NC, Yoshimura, N, Zillikens, MC, Zwart, M, Harvey, NC, Lorentzon, M & Leslie, WD 2025, 'Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX', Osteoporosis International, vol. 36, pp. 653-671. https://doi.org/10.1007/s00198-025-07397-1

@article{c801ced19be14bfb955effbd64f116b3,

title = "Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX",

abstract = "Summary: The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX{\textregistered}. Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. Methods: The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35–1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85–2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis. Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.",

keywords = "epidemiology, fracture risk, FRAX, glucocorticoids, hip fracture, major osteoporotic fracture, meta-analysis, osteoporosis, rheumatoid arthritis, risk factors",

author = "Kanis, {John A.} and Helena Johansson and McCloskey, {Eugene V.} and Enwu Liu and Marian Schini and Liesbeth Vandenput and {\AA}kesson, {Kristina E.} and Anderson, {Fred A.} and Rafael Azagra and Bager, {Cecilie L.} and Charlotte Beaudart and Bischoff-Ferrari, {Heike A.} and Emmanuel Biver and Olivier Bruy{\`e}re and Cauley, {Jane A.} and Center, {Jacqueline R.} and Roland Chapurlat and Claus Christiansen and Cyrus Cooper and Crandall, {Carolyn J.} and Cummings, {Steven R.} and {da Silva}, {Jos{\'e} A.P.} and Bess Dawson-Hughes and Adolfo Diez-Perez and Dufour, {Alyssa B.} and Eisman, {John A.} and Elders, {Petra J.M.} and Serge Ferrari and Yuki Fujita and Saeko Fujiwara and Gl{\"u}er, {Claus Christian} and Inbal Goldshtein and David Goltzman and Vilmundur Gudnason and Jill Hall and Didier Hans and Mari Hoff and Hollick, {Rosemary J.} and Martijn Huisman and Masayuki Iki and Sophia Ish-Shalom and Graeme Jones and Karlsson, {Magnus K.} and Sundeep Khosla and Kiel, {Douglas P.} and Koh, {Woon Puay} and Fjorda Koromani and Kotowicz, {Mark A.} and Heikki Kr{\"o}ger and Timothy Kwok and Olivier Lamy and Arnulf Langhammer and Bagher Larijani and Kurt Lippuner and McGuigan, {Fiona E.A.} and Dan Mellstr{\"o}m and Thomas Merlijn and Nguyen, {Tuan V.} and Anna Nordstr{\"o}m and Peter Nordstr{\"o}m and O´Neill, {Terence W.} and Barbara Obermayer-Pietsch and Claes Ohlsson and Orwoll, {Eric S.} and Pasco, {Julie A.} and Fernando Rivadeneira and Schott, {Anne Marie} and Shiroma, {Eric J.} and Kristin Siggeirsdottir and Simonsick, {Eleanor M.} and Elisabeth Sornay-Rendu and Reijo Sund and Karin Swart and Pawel Szulc and Junko Tamaki and Torgerson, {David J.} and {van Schoor}, {Natasja M.} and {van Staa}, {Tjeerd P.} and Joan Vila and Wright, {Nicole C.} and Noriko Yoshimura and Zillikens, {M. Carola} and Marta Zwart and Harvey, {Nicholas C.} and Mattias Lorentzon and Leslie, {William D.}",

year = "2025",

month = apr,

doi = "10.1007/s00198-025-07397-1",

language = "English",

volume = "36",

pages = "653--671",

journal = "Osteoporosis International",

issn = "1433-2965",

publisher = "SPRINGER-VERLAG LONDON LTD",

}

TY - JOUR

T1 - Rheumatoid arthritis and subsequent fracture risk

T2 - an individual person meta-analysis to update FRAX

AU - Kanis, John A.

AU - Johansson, Helena

AU - McCloskey, Eugene V.

AU - Liu, Enwu

AU - Schini, Marian

AU - Vandenput, Liesbeth

AU - Åkesson, Kristina E.

AU - Anderson, Fred A.

AU - Azagra, Rafael

AU - Bager, Cecilie L.

AU - Beaudart, Charlotte

AU - Bischoff-Ferrari, Heike A.

AU - Biver, Emmanuel

AU - Bruyère, Olivier

AU - Cauley, Jane A.

AU - Center, Jacqueline R.

AU - Chapurlat, Roland

AU - Christiansen, Claus

AU - Cooper, Cyrus

AU - Crandall, Carolyn J.

AU - Cummings, Steven R.

AU - da Silva, José A.P.

AU - Dawson-Hughes, Bess

AU - Diez-Perez, Adolfo

AU - Dufour, Alyssa B.

AU - Eisman, John A.

AU - Elders, Petra J.M.

AU - Ferrari, Serge

AU - Fujita, Yuki

AU - Fujiwara, Saeko

AU - Glüer, Claus Christian

AU - Goldshtein, Inbal

AU - Goltzman, David

AU - Gudnason, Vilmundur

AU - Hall, Jill

AU - Hans, Didier

AU - Hoff, Mari

AU - Hollick, Rosemary J.

AU - Huisman, Martijn

AU - Iki, Masayuki

AU - Ish-Shalom, Sophia

AU - Jones, Graeme

AU - Karlsson, Magnus K.

AU - Khosla, Sundeep

AU - Kiel, Douglas P.

AU - Koh, Woon Puay

AU - Koromani, Fjorda

AU - Kotowicz, Mark A.

AU - Kröger, Heikki

AU - Kwok, Timothy

AU - Lamy, Olivier

AU - Langhammer, Arnulf

AU - Larijani, Bagher

AU - Lippuner, Kurt

AU - McGuigan, Fiona E.A.

AU - Mellström, Dan

AU - Merlijn, Thomas

AU - Nguyen, Tuan V.

AU - Nordström, Anna

AU - Nordström, Peter

AU - O´Neill, Terence W.

AU - Obermayer-Pietsch, Barbara

AU - Ohlsson, Claes

AU - Orwoll, Eric S.

AU - Pasco, Julie A.

AU - Rivadeneira, Fernando

AU - Schott, Anne Marie

AU - Shiroma, Eric J.

AU - Siggeirsdottir, Kristin

AU - Simonsick, Eleanor M.

AU - Sornay-Rendu, Elisabeth

AU - Sund, Reijo

AU - Swart, Karin

AU - Szulc, Pawel

AU - Tamaki, Junko

AU - Torgerson, David J.

AU - van Schoor, Natasja M.

AU - van Staa, Tjeerd P.

AU - Vila, Joan

AU - Wright, Nicole C.

AU - Yoshimura, Noriko

AU - Zillikens, M. Carola

AU - Zwart, Marta

AU - Harvey, Nicholas C.

AU - Lorentzon, Mattias

AU - Leslie, William D.

PY - 2025/4

Y1 - 2025/4

N2 - Summary: The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. Methods: The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35–1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85–2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis. Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

AB - Summary: The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. Methods: The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35–1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85–2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis. Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

KW - epidemiology

KW - fracture risk

KW - FRAX

KW - glucocorticoids

KW - hip fracture

KW - major osteoporotic fracture

KW - meta-analysis

KW - osteoporosis

KW - rheumatoid arthritis

KW - risk factors

UR - https://rdcu.be/ebeM9

UR - https://eprints.soton.ac.uk/499116/

U2 - 10.1007/s00198-025-07397-1

DO - 10.1007/s00198-025-07397-1

M3 - Article

SN - 1433-2965

VL - 36

SP - 653

EP - 671

JO - Osteoporosis International

JF - Osteoporosis International

ER -

Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX

Abstract

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Keywords

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