Osteoporosis International

, Volume 29, Issue 6, pp 1263–1275 | Cite as

Incidence of fractures among patients with rheumatoid arthritis: a systematic review and meta-analysis

  • S. Jin
  • E. HsiehEmail author
  • L. Peng
  • C. Yu
  • Y. Wang
  • C. Wu
  • Q. Wang
  • M. LiEmail author
  • X. Zeng
Original Article



This study is the first meta-analysis investigating the pooled incidence rates of fractures among patients with RA. Our results demonstrated that this population is at high risk of overall and fragility fractures. Consideration of vertebral imaging and RA-specific risk factor assessment may aid in fracture prevention for this vulnerable group.


This systematic review and meta-analysis aims to estimate the incidence of fractures (overall and fragility) in patients with rheumatoid arthritis (RA).


MEDLINE, EMBASE, and CENTRAL were searched for cohort studies reporting incidence of fractures among patients with RA. Two reviewers independently assessed all studies for inclusion and extracted data. Pooled analyses of incidence rates and relative risk of fractures were conducted using a random-effects model. Subgroup analyses investigated potential sources of heterogeneity, and predictors of fractures were summarized.


Twenty-five studies were included in total. The pooled incidence rates of overall and fragility fractures were 33.00 (95% CI 18.39–59.21) and 15.31 (95% CI 10.43–22.47) per 1000 person-years, respectively. Patients with RA had a higher risk of overall (RR 1.52, 95% CI 1.07–2.14) and fragility (RR 1.61, 95% CI 1.44–1.79) fractures. Subgroup analyses suggested a higher risk of fragility fractures among female patients (31.03 vs. 23.75 per 1000 person-years). The pooled site-specific incidence rates of vertebral, hip, forearm, and proximal humeral fractures were 7.51 (95% CI 3.27–17.23), 4.33 (95% CI 2.26–8.27), 3.40 (95% CI 2.27–5.10), and 1.86 (95% CI 1.36–2.53) per 1000 person-years, respectively. Clinical vertebral fractures were underestimated compared with radiographic screening (4.29 vs. 42.40 per 1000 person-years). Predictors of fractures included both traditional OP risk factors and RA-specific factors.


Patients with RA are at high risk of incident overall and fragility fractures. Consideration of vertebral imaging for patients with additional OP risk factors, including RA-specific risk factors, may help with early OP diagnosis and timely intervention.


Fracture incidence Fragility fracture Meta-analysis Osteoporosis Rheumatoid arthritis 



This study was supported by the Chinese National Key Technology R&D Program (2017YFC0907601, 2017YFC0907604).

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2018_4473_MOESM1_ESM.doc (140 kb)
ESM 1 (DOC 140 kb)
198_2018_4473_MOESM2_ESM.doc (1.4 mb)
ESM 2 (DOC 1398 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Department of Rheumatology, Peking Union Medical College HospitalPeking Union Medical College & Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of EducationBeijingChina
  2. 2.Section of Rheumatology, Yale School of MedicineNew HavenUSA
  3. 3.Department of Epidemiology and Bio-statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic MedicinePeking Union Medical CollegeBeijingChina

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