title: Arthritis increases the risk for fractures--results from the Women's Health Initiative.
abstract: OBJECTIVE
  To examine the relationship between arthritis and fracture.
  
  
  METHODS
  Women were classified into 3 self-reported groups at baseline: no arthritis (n = 83,295), osteoarthritis (OA; n = 63,402), and rheumatoid arthritis (RA; n = 960). Incident fractures were self-reported throughout followup. Age-adjusted fracture rates by arthritis category were generated, and the Cox proportional hazards model was used to test the association between arthritis and fracture.
  
  
  RESULTS
  After an average of 7.80 years, 24,137 total fractures were reported including 2559 self-reported clinical spinal fractures and 1698 adjudicated hip fractures. For each fracture type, age-adjusted fracture rates were highest in the RA group and lowest in the nonarthritic group. After adjustment for several covariates, report of arthritis was associated with increased risk for spine, hip, and any clinical fractures. Compared to the nonarthritis group, the risk of sustaining any clinical fracture in the OA group was HR 1.09 (95% CI 1.05, 1.13; p < 0.001) and HR 1.49 (95% CI 1.26, 1.75; p < 0.001) in the RA group. The risk of sustaining a hip fracture was not statistically increased in the OA group (HR 1.11; 95% CI 0.98, 1.25; p = 0.122) compared to the nonarthritis group; however, the risk of hip fracture increased significantly (HR 3.03; 95% CI 2.03, 4.51; p < 0.001) in the RA group compared to the nonarthritis group.
  
  
  CONCLUSIONS
  The increase in fracture risk confirms the importance of fracture prevention in patients with RA and OA.
authors.affiliation: Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA. ncwright@uab.edu
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Wright
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Lisse
authors.forename: Brian T
authors.initials: BT
authors.lastname: Walitt
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: Zhao
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000368:Aged; D001168:Arthritis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D015519:Bone Density; D002986:Clinical Trials as Topic; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D016387:Women's Health