Al-Hilali, Hussain and Emerson, Molly and Amin, Hamzah and Bukhari, Marwan (2026) E092 Age-specific fracture patterns in rheumatoid arthritis: clues to early skeletal fragility. Rheumatology, 65 (Supple). ISSN 1462-0324
Full text not available from this repository.Abstract
Background/Aims Rheumatoid arthritis (RA) is known to increase fracture risk, but age-specific patterns are often overlooked. Standard risk-stratification tools such as FRAX are strongly age-dependent and record previous fracture as a single yes/no item, without any details of the fracture site. We asked whether fracture site differs by age (<65 vs ≥ 65 years) in RA, and whether any differences could act as early clinical indicators of skeletal fragility to prompt earlier intervention. Methods We conducted a retrospective cohort study of RA patients referred for dual-energy X-ray absorptiometry (DEXA) from 2004-2021 in Northwest England. Patients were age-stratified (<65/≥65), and fractures were coded by anatomical site. We compared site distributions (chi-squared) and modelled age-site associations using univariable logistic regression, reporting odds ratios (OR; ≥65 vs < 65) with 95% confidence intervals (CI). Results Among 2,649 patients (median age 67.9; 77% female), 921 (34.8%) had ≥1 fracture. The distribution of fracture sites differed by age (p < 0.001). Older adults had higher odds of spine (OR 1.67), femur (1.67) and forearm (1.42) fractures, whereas younger patients more often sustained wrist (0.57) and ankle/foot (0.39) fractures. No age-related differences were seen for humerus, pelvis, ribs or hand (all p > 0.05). Conclusion Fracture site has age-specific meaning in RA. In patients under 65, peripheral fractures (wrist, ankle/foot) should prompt early investigation for skeletal fragility. Integrating fracture site into routine care with timely DEXA scanning, a focused review of FRAX inputs and bone-protective therapy where appropriate could shorten time to diagnosis and treatment, and better capture early signs of risk that age-weighted tools may miss. Disclosure H. Al-Hilali: None. M. Emerson: None. H. Amin: None. M. Bukhari: None.