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
{"title":"Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX.","authors":"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","DOIUrl":null,"url":null,"abstract":"<p><p>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®.</p><p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19638,"journal":{"name":"Osteoporosis International","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Osteoporosis International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00198-025-07397-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX.
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.
期刊介绍：
An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases.
It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition.
While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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