In patients with rheumatoid arthritis (RA), higher frailty status is significantly associated with an increased risk for osteoporotic fractures, according to study results published in Bone.
Previous studies have shown that patients with RA are at an increased risk for skeletal bone loss and osteoporotic fractures. It is also well known that frailty — a condition that limits social, psychological, and physical function — may increase the risk for future adverse health outcomes. However, scarce data are available regarding the association between frailty and the risk for adverse health outcomes in patients with RA.
The goal of this study was to investigate the association between frailty and the risk for osteoporotic fractures in patients with RA.
The study was based on data from the Ontario Best Practices Research Initiative, a clinical registry of patients with RA in Ontario, Canada. The analysis included patients who completed ≥2 visits between January 2010 and December 2016. The primary study outcome was time to first incident osteoporotic fracture. A secondary outcome was hospitalization for any cause during follow-up.
Frailty was assessed according to the Rockwood-type frailty index in patients with RA. The frailty index consisted of 32 health-related deficits rated from 0 to 1, with a higher total frailty index pointing to greater frailty.
The study cohort included 2923 participants (78% women; mean age, 57.7 ± 12.7 years). During a mean follow-up of 3.7 ± 1.9 years, 125 new osteoporotic fractures were documented (incidence rate, 4.3%), including 21 forearm or wrist fractures, 10 spine, 12 hip, 8 shoulder, 16 ankle, 13 foot, 11 rib, 7 femur, 6 elbow, 4 pelvis, and 17 other fractures.
The frailty index was significantly higher in patients with a fracture compared with control participants (0.24 vs 0.2, respectively; P =.02). Multivariable linear regression analysis also supported a statistically significant difference in frailty index between patients with a fracture and control participants (mean difference, 0.02; P =.03).
Furthermore, frailty index was significantly associated with an increased risk for fracture in the fully adjusted models, with a 4% increased risk (hazard ratio [HR], 1.04; 95% CI, 1.02-1.06; P <.001) and a 58% increased risk (HR, 1.58; 95% CI, 1.32-1.89, P <.001) per 0.01 and per standard deviation increase in the frailty index, respectively.
There was also an association between frailty index and the risk for all-cause hospitalization in fully adjusted models, with a 3% increased risk (odds ratio [OR], 1.03; 95% CI, 1.02-1.04; P <.001) and 43% increased risk (OR, 1.43; 95% CI, 1.30-1.58; P <.001) per 0.01 and per standard deviation increase in the frailty index, respectively.
Possible study limitations included the observational design, as well as the lack of information regarding radiologic imaging such as bone mineral density measures; thus the researchers could not determine whether frailty was related to osteoporotic fracture risk independent of bone density.
“[O]ur study demonstrates that higher frailty status is significantly related to increased risk of osteoporotic fractures in patients with RA,” concluded the researchers. “Quantifying the frailty status as a research tool may aid in fracture risk assessment, management and decision-making in RA.”
Li G, Chen M, Li X, et al. Frailty and risk of osteoporotic fractures in patients with rheumatoid arthritis: data from the Ontario Biologics Research Initiative. Bone. 2019;127:129-134.