Validating the Fracture Risk Assessment Tool Score in a US Population-Based Study of Patients With Rheumatoid...

Area of Science:

• Rheumatology
• Epidemiology
• Gerontology

Background:

• Rheumatoid arthritis (RA) is associated with an increased risk of osteoporotic and hip fractures.
• The World Health Organization fracture risk assessment tool (FRAX) algorithm incorporates RA as a risk factor but requires validation in US-based RA cohorts.
• Accurate fracture risk prediction is crucial for managing patients with RA.

Purpose of the Study:

• To validate the accuracy of the FRAX algorithm for predicting major osteoporotic and hip fractures in a US population with rheumatoid arthritis.
• To compare FRAX predictions with observed fracture incidence in RA patients.

Main Methods:

• Retrospective, population-based cohort study in Olmsted County, Minnesota.
• Matched 1:1 cohort of 662 RA patients and 658 non-RA comparators (age 40-89, 1980-2007).
• Ten-year fracture risk estimated using FRAX; observed fractures ascertained through follow-up (median 9.0 years).

Main Results:

• Among RA patients, observed major osteoporotic fractures (76) and hip fractures (21) were similar to FRAX predictions (67.0 and 23.3, respectively).
• Standardized incidence ratios (SIRs) for major osteoporotic fractures (1.13) and hip fractures (0.90) indicated good agreement between observed and predicted risks.
• Fracture risk predictions were comparable between RA patients and non-RA comparators.

Conclusions:

• The FRAX tool demonstrates accuracy in estimating major osteoporotic and hip fracture risk for individuals with rheumatoid arthritis in the US.
• FRAX can be reliably used to assess fracture risk in RA patients, aiding in clinical decision-making.
• The findings support the continued use of FRAX in managing fracture risk within the RA population.