Evidence map›Paper›PMID 39955689›Full record

SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

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 and 76 more

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Predictive value of BMD for hip and other fractures: a meta-analysis to update FRAX.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Pooled it
  2. Secondary fracture risk after hip fracture in older patients: an updated sex-specific systematic review and meta analysis with GRADE and PAF assessment.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Pooled it
  3. Pooled it
  4. Body mass index and subsequent fracture risk: a meta-analysis to update FRAX.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025
    Pooled it
  5. Pooled it
  6. From Risk to Treatment: Clinical Updates in Osteoporosis Management.International journal of rheumatic diseases · 2026
    Article
  7. Management of glucocorticoid-induced osteoporosis in rheumatic diseases.Best practice & research. Clinical rheumatology · 2026
    Review
  8. Bone Health in Rheumatoid Arthritis: An Update.Current rheumatology reports · 2026
    Review
  9. Article
  10. Review
  11. [Methotrexate osteopathy-a critical review].Zeitschrift fur Rheumatologie · 2026
    Review
  12. Article
  13. Article
  14. Article
  15. Anticholinergic burden and bone health in rheumatoid arthritis.Revista da Associacao Medica Brasileira (1992) · 2026
    Article
  16. Review
  17. Rheumatoid arthritis and subsequent fracture risk.Journal of bone and mineral metabolism · 2025
    Article
  18. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

86 authors.

John A KanisCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.Pontefract@sheffield.ac.uk.ORCID http://orcid.org/0000-0002-3129-4326
Helena JohanssonCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Eugene V McCloskeyCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.ORCID http://orcid.org/0000-0003-0177-8140
Enwu LiuSouth Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
Marian SchiniDivision of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
Liesbeth VandenputSahlgrenska Osteoporosis Centre, University of Gothenburg, Gothenburg, Sweden.ORCID http://orcid.org/0000-0002-1712-6131
Kristina E ÅkessonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Fred A AndersonGLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
Rafael AzagraDepartment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.ORCID http://orcid.org/0000-0003-0093-333X
Cecilie L BagerNordic Bioscience A/S, Herlev, Denmark.
Charlotte BeaudartWHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Heike A Bischoff-FerrariDepartment of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Emmanuel BiverDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.ORCID http://orcid.org/0000-0001-6174-1951
Olivier BruyèreResearch Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Jane A CauleyDepartment of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.ORCID http://orcid.org/0000-0003-0752-4408
Jacqueline R CenterSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-5278-4527
Roland ChapurlatINSERM UMR 1033, Hôpital Edouard Herriot, Université Claude Bernard-Lyon1, Lyon, France.
Claus ChristiansenNordic Bioscience A/S, Herlev, Denmark.
Cyrus CooperMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.ORCID http://orcid.org/0000-0003-3510-0709
Carolyn J CrandallDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Steven R CummingsSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
José A P da SilvaCoimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.ORCID http://orcid.org/0000-0002-2782-6780
Bess Dawson-HughesBone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA.ORCID http://orcid.org/0000-0003-3136-0386
Adolfo Diez-PerezDepartment of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
Alyssa B DufourMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
John A EismanSkeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0002-7162-7471
Petra J M EldersDepartment of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Serge FerrariDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Yuki FujitaDepartment of Hygiene and Public Health, Faculty of Medicine, Kansai Medical University, Osaka, Japan.ORCID http://orcid.org/0000-0002-7490-258X
Saeko FujiwaraDepartment of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
Claus-Christian GlüerSection Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
Inbal GoldshteinMaccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.ORCID http://orcid.org/0000-0002-5317-2848
David GoltzmanDepartment of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
Vilmundur GudnasonIcelandic Heart Association, Kopavogur, Iceland.
Jill HallMRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
Didier HansInterdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
Mari HoffDepartment of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.ORCID http://orcid.org/0000-0002-9992-8663
Rosemary J HollickAberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK.
Martijn HuismanDepartment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Masayuki IkiDepartment of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan.
Sophia Ish-ShalomEndocrine Clinic, Elisha Hospital, Haifa, Israel.
Graeme JonesMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Magnus K KarlssonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Sundeep KhoslaRobert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
Douglas P KielMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
Woon-Puay KohHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.ORCID http://orcid.org/0000-0002-5674-6341
Fjorda KoromaniDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Mark A KotowiczIMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia.ORCID http://orcid.org/0000-0002-8094-1411
Heikki KrögerDepartment of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.ORCID http://orcid.org/0000-0003-4245-8186
Timothy KwokDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China.ORCID http://orcid.org/0000-0001-9253-3549
Olivier LamyCentre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
Arnulf LanghammerHUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Bagher LarijaniEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Kurt LippunerDepartment of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland.
Fiona E A McGuiganClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
Dan MellströmGeriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Thomas MerlijnDepartment of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Tuan V NguyenSchool of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.ORCID http://orcid.org/0000-0002-3246-6281
Anna NordströmSchool of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Peter NordströmDepartment of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Terence W O NeillNational Institute for Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK.ORCID http://orcid.org/0000-0002-8896-4677
Barbara Obermayer-PietschDepartment of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.ORCID http://orcid.org/0000-0003-3543-1807
Claes OhlssonSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Eric S OrwollDepartment of Medicine, Oregon Health and Science University, Portland, OR, USA.ORCID http://orcid.org/0000-0002-8520-7355
Julie A PascoIMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia.ORCID http://orcid.org/0000-0002-8968-4714
Fernando RivadeneiraDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Anne-Marie SchottUniversité Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
Eric J ShiromaLaboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA.
Kristin SiggeirsdottirIcelandic Heart Association, Kopavogur, Iceland.
Eleanor M SimonsickTranslational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA.
Elisabeth Sornay-RenduINSERM UMR 1033, Hôpital Edouard Herriot, University of Lyon, Lyon, France.
Reijo SundKuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.ORCID http://orcid.org/0000-0002-6268-8117
Karin SwartDepartment of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
Pawel SzulcINSERM UMR 1033, Hôpital Edouard Herriot, University of Lyon, Lyon, France.ORCID http://orcid.org/0000-0003-4168-6697
Junko TamakiDepartment of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
David J TorgersonYork Trials Unit, Department of Health Sciences, University of York, York, UK.
Natasja M van SchoorDepartment of Epidemiology and Data Science, Location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-0870-0795
Tjeerd P van StaaCentre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.
Joan VilaStatistics Support Unit, CIBER Epidemiology and Public Health (CIBERESP), Hospital del Mar Medical Research Institute, Barcelona, Spain.
Nicole C WrightDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Noriko YoshimuraDepartment of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
M Carola ZillikensDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.ORCID http://orcid.org/0000-0001-9186-3423
Marta ZwartGROIMAP/GROICAP (Research Groups), Unitat de Suport a La Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
Nicholas C HarveyMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Mattias LorentzonSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
William D LeslieDepartment of Medicine, University of Manitoba, Winnipeg, MB, Canada.ORCID http://orcid.org/0000-0002-1056-1691

Funding

Oregon Clinical and Translational Research InstituteUL1TR000128 · NCATS · OREGON HEALTH & SCIENCE UNIVERSITY · PI ELLISON, DAVID H · 2012 to 2015
$28.7M
Osteoporotic Fractures in Men (MrOS) - San Francisco Coordinating CenterU01AR066160 · NIAMS · CALIFORNIA PACIFIC MED CTR RES INSTITUTE · PI CUMMINGS, STEVEN RON · 2013 to 2017
$9.3M
NCATS NIH HHS UL1 TR000128NIAMS NIH HHS U01 AR066160
6 · The paper itself

Abstract

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®.

introductionRA 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.

methodsThe 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.

resultsIn 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.

conclusionsA 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.

Indexed as

Arthritis, RheumatoidOsteoporotic FracturesAdultAgedAged, 80 and overAge FactorsAlgorithmsBone DensityFemaleHip FracturesHumansMaleMiddle AgedRisk AssessmentRisk FactorsSex FactorsEpidemiologyFracture riskFRAXGlucocorticoidsHip fractureMajor osteoporotic fractureMeta-analysisOsteoporosisRheumatoid arthritisRisk factors

Identifiers

PMID39955689

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.