August 1, 2011

Using data from the Women’s Health Initiative (WHI), researchers supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have improved the understanding of the association between arthritis and the risk of broken bones (fractures). Their findings underscore the need for bone health strategies in people with arthritis, including osteoarthritis — a condition that was once considered to be "protective" against fractures.

Fractures are a common consequence of osteoporosis, a disease marked by reduced bone strength. Rheumatoid arthritis (RA), an inflammatory condition affecting the joints, is a well-established risk factor for osteoporosis and fractures. Conversely, osteoarthritis (OA), the most common form of arthritis, has not been associated with an increased risk of fractures.

Zhao Chen, Ph.D., of the Mel and Enid Zuckerman College of Public Health at the University of Arizona, and her colleagues sought to investigate the risk of fractures among women enrolled in the WHI. The Initiative afforded the researchers an opportunity to study a large number of women, 43 percent of whom reported osteoarthritis, and to scrutinize the risk for all types of fracture.

Of the women who reported a history of arthritis, 63,402 met the criteria for the OA group, and 960 met the criteria for the RA group. A total of 83,295 women who did not have arthritis comprised the control group. These women were followed for nearly eight years, and the occurrence of clinical fractures in the OA, RA and the non-arthritis control groups was recorded.

Investigators learned that, when compared with WHI participants who did not have arthritis, both the RA and OA groups had a significant increase in fractures. The increased risk in the RA group was highly significant and pertained to all fractures studied, while the OA group had a modest, but significant, increase in total fractures and spine fractures, but not in hip fractures — in agreement with earlier studies that focused only on hip fractures. The investigators concluded that the observed increase in fracture risk in both groups confirms the need for fracture prevention in people with RA and OA.

The WHI, led by the National Institutes of Health's National Heart, Lung, and Blood Institute, is a major research program that addresses the most common causes of death, disability and poor quality of life in postmenopausal women. The Initiative consisted of a set of clinical trials and an observational study, which together involved 161,808 generally healthy, postmenopausal women.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about the NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at For more information on osteoporosis and bone health, call the NIH Osteoporosis and Related Bone Diseases ñ National Resource Center (NRC) at (202) 223-0344 or (800) 624-2663 (free call) or visit the NRC website at


Wright NC, Lisse JR, Walitt BT, Eaton CB, Chen Z. Arthritis Increases the Risk for Fractures — Results from the Women's Health Initiative. J Rheumatol. 2011 May 15.

Last Reviewed: