High disease activity is associated with incident osteoporotic fractures among veterans with rheumatoid arthritis
Main finding · Incident osteoporotic fracture per unit increase of DAS28-ESR (time-varying model)Result — go to the resultAdjusted hazard ratio 1.18 95% CI 1.09–1.28Authors' conclusion
Time-varying and cumulative RA disease activity are associated with incident osteoporotic fracture.
Study context
- Population
- Veterans with rheumatoid arthritis (RA) in the multicentre Veterans Affairs RA (VARA) registry248 (9%) fractured
- Participants
- 2,912 veterans
- Exposure
- RA disease activity and its components vs incident osteoporotic fracture
- Fracturen = 248
- Outcome
- Incident osteoporotic fracture (ICD9/10 codes, validated by chart review)
Methodological detailsmulticentre registry (VARA), multivariable Cox regression, time-varying and cumulative disease activity models
- Multicentre registry (VARA)
- Multivariable Cox regression
- Time-varying and cumulative disease activity models
Main finding
As reported in the abstract
Incident osteoporotic fracture per unit increase of DAS28-ESR (time-varying model)
Adjusted hazard ratio
1.18
95% CI 1.09–1.28
P < 0.001
Per unit increase of DAS28-ESR
aHR 1.18 (95% CI 1.09–1.28); P < 0.001
Per unit increase of DAS28-ESR, as printed
Observational data: associations, not effects.
Further findings
| Outcome | aHR for incident osteoporotic fracture (95% CI) | P value | |
|---|---|---|---|
| Incident osteoporotic fracture, cumulative model (per DAS28-ESR unit-year)3% increased risk per DAS28-ESR unit-year | 1.03 (1.01–1.05) | P < 0.001 | |
| 0.512AHR for incident osteoporotic fracture (log scale) |
| Outcome | aHR for incident osteoporotic fracture | P value |
|---|---|---|
| Incident osteoporotic fracture by DAS28-ESR category (sensitivity analysis)Moderate disease activity vs Remission | 2.24 | P < 0.01 |
| Incident osteoporotic fracture by DAS28-ESR category (sensitivity analysis)High disease activity vs Remission | 2.01 | P < 0.01 |
- Incident osteoporotic fracture by DAS28-ESR category (sensitivity analysis): 2-fold risk of incident osteoporotic fracture
DAS28-ESR components
- Patient global assessment of disease activity had the highest point estimates of the disease activity components in both time-varying and cumulative models
Original publication
High disease activity is associated with incident osteoporotic fractures among veterans with rheumatoid arthritis. Joint Bone Spine. Published 17 December 2025. doi:10.
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