Risk factors for osteoporosis in rheumatoid arthritis patients: a meta-analysis

The purpose of this investigation was to determine risk factors for osteoporosis (OP) in patients with rheumatoid arthritis (RA) through comprehensive literature review and meta-analysis.

A comprehensive database exploration covered PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and Chinese Biomedical databases from inception to December 31, 2024. Study quality was assessed using the Newcastle-Ottawa Scale for Healthcare Research and Quality (AHRQ). Data analyses involved STATA 18 to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Publication bias assessment involved funnel plots in conjunction with Egger's test.

Fifty-seven articles were incorporated in the meta-analysis. Significant risk factors for OP in RA patients included female (OR = 2.10), advancing age (OR = 1.11), prior fracture (OR = 2.83), disease duration (OR = 1.16), and postmenopausal status (OR = 3.96). Laboratory and clinical parameters that correlated with increased risk included elevated CTX (OR = 1.01), higher DAS28 scores (OR = 1.60), increased ESR (OR = 1.05), higher Sharp Scores (OR = 1.12), and RF titers (OR = 1.01). Glucocorticoid therapy constituted a significant risk factor (OR = 2.34). Protective factors included higher BMI (OR = 0.86), adequate 25-(OH)-D levels (OR = 0.88), and calcium and/or vitamin D supplementation (OR = 0.49). No significant associations were found between OP in individuals with RA and smoking history, alcohol consumption, PTH levels, or DMARD therapy. This meta-analysis systematically identified risk factors for OP among individuals with RA. Female, advanced age, prior fracture, longer disease duration, postmenopausal status, CRP, ESR, CTX, RF titers, DAS28, Sharp Score, and glucocorticoid therapy increased OP risk. Conversely, higher BMI, adequate 25-(OH)-D status, and calcium/vitamin D supplementation demonstrated protective effects.

This meta-analysis reveals female, age, postmenopausal status, prior fracture, and glucocorticoid therapy as major risk factors for osteoporosis in rheumatoid arthritis, with higher BMI as protective factors to quantify the impact of each risk factor and provide strategies for individualized prevention.