High disease activity is associated with incident osteoporotic fractures among veterans with rheumatoid arthritis

IF 4.3 3区医学 Q1 RHEUMATOLOGY

Joint Bone Spine Pub Date : 2026-05-01 Epub Date: 2025-12-17 DOI:10.1016/j.jbspin.2025.106020

Katherine D. Wysham , Hannah F. Brubeck , Aaron Baraff , Punyasha Roul , Marianna Olave , John S. Richards , Paul Monach , Dolores M. Shoback , Patricia P. Katz , Brian C. Sauer , Beth Wallace , Jose M. Garcia , Grant W. Cannon , Ted R. Mikuls , Bryant R. England , Joshua F. Baker

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引用次数: 0

Abstract

Objectives

Rheumatoid arthritis (RA) increases osteoporosis and fracture risk. The relationship between disease activity and fracture is not well characterized. We aimed to study whether RA disease activity and its components were associated with incident osteoporotic fracture.

Methods

Data were from the multicenter Veterans Affairs RA (VARA) registry. Fractures were identified by ICD9/10 codes and validated by chart review. Multivariable Cox regression was used to quantify associations of time-varying and cumulative RA disease activity, using DAS28-ESR, with incident osteoporotic fracture. To directly compare hazard ratios (HRs), DAS28-ESR components were scaled, centered and evaluated in multivariable models. Sensitivity analyses, including evaluating DAS28-ESR categories, were also performed.

Results

Among 2912 veterans, 248 (9%) experienced incident osteoporotic fracture. Those who fractured were more likely to be female (19 versus 11%), White (83 vs. 75%) and had higher baseline disease activity (DAS28-ESR 4.0 ± 1.5 vs. 3.8 ± 1.6). The time-varying model demonstrated an 18% increased risk of incident osteoporotic fracture per unit increase of DAS28-ESR (aHR 1.18 [95% CI 1.09–1.28], P < 0.001). The cumulative model revealed a 3% increased risk per DAS28-ESR unit-year (aHR 1.03 [95% CI 1.01–1.05], P < 0.001). Patient global assessment of disease activity had the highest point estimates of the disease activity components in both time-varying and cumulative models. Compared to remission, moderate and high disease activity carried a 2-fold risk of incident osteoporotic fracture (aHR 2.24 and 2.01 respectively, both P < 0.01).

Conclusion

Time-varying and cumulative RA disease activity are associated with incident osteoporotic fracture. These data support achieving low disease activity or remission to reduce the risk of incident osteoporotic fracture.

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高疾病活动度与类风湿关节炎退伍军人骨质疏松性骨折发生率相关

目的：类风湿关节炎（RA）增加骨质疏松和骨折的风险。疾病活动度与骨折之间的关系尚未明确。我们的目的是研究RA疾病活动性及其成分是否与骨质疏松性骨折的发生有关。方法：数据来自多中心退伍军人事务RA （VARA）登记。骨折采用ICD9/10编码识别，并通过图表评审进行验证。采用多变量Cox回归，使用DAS28-ESR量化时变和累积类风湿性关节炎疾病活动性与骨质疏松性骨折的关联。为了直接比较风险比（hr），在多变量模型中对DAS28-ESR成分进行了缩放、居中和评估。敏感性分析，包括评估DAS28-ESR分类，也进行了。结果：2912名退伍军人中，248名（9%）发生骨质疏松性骨折。骨折患者多为女性（19%对11%）、白人（83%对75%），基线疾病活动性较高（DAS28-ESR 4.0±1.5对3.8±1.6）。时变模型显示，DAS28-ESR每增加一个单位，骨质疏松性骨折的发生风险增加18% （aHR 1.18 [95%CI 1.09-1.28]）。结论：时变和累积性RA疾病活度与骨质疏松性骨折的发生有关。这些数据支持实现低疾病活动度或缓解以降低发生骨质疏松性骨折的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Joint Bone Spine 医学-风湿病学

CiteScore

4.50

自引率

11.90%

发文量

184

审稿时长

25 days

期刊介绍： Bimonthly e-only international journal, Joint Bone Spine publishes in English original research articles and all the latest advances that deal with disorders affecting the joints, bones, and spine and, more generally, the entire field of rheumatology. All submitted manuscripts to the journal are subjected to rigorous peer review by international experts: under no circumstances does the journal guarantee publication before the editorial board makes its final decision. (Surgical techniques and work focusing specifically on orthopedic surgery are not within the scope of the journal.)Joint Bone Spine is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey platforms.