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Fracture prediction in rheumatoid arthritis : Validation of FRAX with bone mineral density for incident major osteoporotic fractures
Richards, Ceri Stevens, Richard Lix, Lisa M. McCloskey, Eugene V. Johansson, Helena Harvey, Nicholas C. Kanis, John A. Leslie, William D.
Richards, Ceri
Stevens, Richard
Lix, Lisa M.
McCloskey, Eugene V.
Johansson, Helena
Harvey, Nicholas C.
Kanis, John A.
Leslie, William D.
Abstract
Objectives
FRAX uses clinical risk factors, with or without BMD, to calculate 10-year fracture risk. RA is a risk factor for osteoporotic fracture and a FRAX input variable. FRAX predates the current era of RA treatment. We examined how well FRAX predicts fracture in contemporary RA patients.
Methods
Administrative data from patients receiving BMD testing were linked to the Manitoba Population Health Research Data Repository. Observed cumulative 10-year major osteoporotic fracture (MOF) probability was compared with FRAX-predicted 10-year MOF probability with BMD for assessing calibration. MOF risk stratification was assessed using Cox regression.
Results
RA patients (n = 2099, 208 with incident MOF) and non-RA patients (n = 2099, with 165 incident MOF) were identified. For RA patients, FRAX-predicted 10-year risk was 13.2% and observed 10-year MOF risk was 13.2% (95% CI 11.6, 15.1). The slope of the calibration plot was 0.67 (95% CI 0.53, 0.81) in those with RA vs 0.98 (95% CI 0.61, 1.34) in non-RA patients. Risk was overestimated in RA patients with high FRAX scores (>20%), but FRAX was well calibrated in other groups. FRAX stratified risk in those with and without RA [hazard ratio (HR) 1.52 (95% CI 1.25, 1.72) vs 2.00 (95% CI 1.73, 2.31)], with slightly better performance in the latter (P for interaction = 0.004).
Conclusions
FRAX predicts fracture risk in contemporary RA patients but may slightly overestimate risk in those already at high predicted risk. Thus the current FRAX tool continues to be appropriate for fracture risk assessment in RA patients.
Keywords
rheumatoid arthritis, FRAX, dual-energy X-ray absorptiometry, osteoporosis, fracture risk prediction, rheumatic disease, fracture
Date
2025
Type
Journal article
Journal
Rheumatology
Book
Volume
64
Issue
1
Page Range
228-234
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled
Notes
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.