Osteoporosis, bone & mineral

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

Osteoporos IntPublished Systematic review and meta-analysis of individual-level data from prospective cohorts

Pooled result · Any clinical fractureResult — go to the resultHazard ratio 1.49 95% CI 1.35–1.65

Authors' conclusion

A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids.

Study context

Population
Men and women aged 20–116 years from 29 prospective cohorts with rheumatoid arthritis (RA) prevalence 3% or less (primary analysis); additional 17 cohorts with prevalence >3% (supplementary analysis)
Participants
1,909,896 men29 prospective cohorts
Comparison
RA vs no RA
Outcome
Any clinical fracture
Methodological detailsinternational, individual person meta-analysis, random-effects meta-analysis, extension of Poisson regression model
  • International
  • Individual person meta-analysis
  • Random-effects meta-analysis
  • Extension of Poisson regression model

Pooled result

As reported in the abstract

Hazard ratio

1.49

95% CI 1.35–1.65

RAvs No RA
HR 1.49 (95% CI 1.35–1.65)

Further pooled results

OutcomeHR (95% CI)
Hip fracture2.23 (1.85–2.69)
  • Hip fracture: 27,518 hip fractures

Hip fracture

Significant interaction with age, higher HRs at younger ages

Osteoporotic fracture and major osteoporotic fracture (MOF)

HRs of similar magnitude to any clinical fracture

By sex, glucocorticoid exposure and femoral neck bone mineral density (BMD)

HRs did not differ between men and women and were independent of GC exposure and femoral neck BMD

Supplementary analysis cohorts (RA prevalence >3%)

Lower HRs, particularly with high apparent RA prevalence, possibly from conflation of RA with OA

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Rheumatoid arthritis and subsequent fracture risk: an individual person meta-analysis to update FRAX. Osteoporos Int. Published 16 February 2025. doi:10.1007/s00198-025-07397-1

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