Adults with rheumatoid arthritis and higher measures indicating frailty were more likely to sustain an osteoporotic fracture during 4 years of follow-up vs. similar patients with lower indicators of frailty, according to an analysis of Canadian registry data published in Bone.
“Higher frailty status is significantly related to increased risk of osteoporotic fractures in patients with rheumatoid arthritis,” Guowei Li, PhD, MSc, MBBS, associate director of the Center for Clinical Epidemiology and Methodology at Guangdong Second Provincial General Hospital in China and assistant professor from the department of health research methods, evidence and impact at McMaster University in Ontario, Canada, told Endocrine Today. “Currently the prediction of osteoporotic fracture risk for patients with [rheumatoid arthritis] remains unsatisfactory; quantifying frailty status may aid in fracture risk assessment, management and decision-making in [rheumatoid arthritis] in clinical practice.”
Li and colleagues analyzed data from 2,923 patients with active rheumatoid arthritis identified via the Ontario Best Practices Research Initiative, a clinical registry of patients with rheumatoid arthritis receiving antirheumatic medications (mean age, 58 years; 78% women; enrolled between 2010-2016). Registry data were collected by participating rheumatologists every 6 months and from trained interviewers every 3 months for the first 2 years, and every 6 months after. Frailty was measured by a Rockwood-type frailty index that included 32 health-related deficits, including activities of daily living, comorbidities and physical signs and symptoms (frailty index ranged from 0 to 1, with higher score indicating greater frailty). Primary outcome was time to first incident osteoporotic fracture during follow-up that led to a hospitalization or ED visit. Researchers used Cox proportional hazards models to assess the association between frailty and fracture risk in patients with rheumatoid arthritis.
At baseline, mean frailty index score for the cohort was 0.2.
During a mean follow-up of 3.7 years, researchers observed 125 (4.3%) incident fractures, including 21 forearm or wrist fractures, 10 spine fractures and 12 hip fractures. Patients who sustained a fracture were older, more likely to be women and had a longer rheumatoid arthritis duration vs. those who did not sustain a fracture, according to researchers.
Patients who experienced a fracture during follow-up had a higher baseline frailty index score vs. controls (mean score, 0.24 vs. 0.2; P = .02).
Researchers found that frailty index score predicted the risk for fracture in the fully adjusted models, with a HR of 1.04 (95% CI, 1.02-1.05) and 1.58 (95% CI, 1.32-1.89) for per-0.01 and per-standard deviation increase in the frailty index score, respectively.
“Based on data from patients with [rheumatoid arthritis], we found the participants experiencing an osteoporotic fracture were significantly frailer than their controls,” the researchers wrote. “We also observed that higher frailty status was significantly related to increased risk of fractures and hospitalizations. Results from subgroup and sensitivity analyses corroborated the robustness of the main findings.”
Li said it is important to identify how to practically and promptly measure frailty status in busy clinics and how to incorporate frailty status into the existing prediction tools for osteoporotic fracture risk assessment.
Frailty and risk of osteoporotic fractures in patients with rheumatoid arthritis: Data from the Ontario Best Practices Research Initiative