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Research"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Rheumatoid arthritis (RA) is associated with an increased risk of frailty and osteoporosis, but the relationship between frailty and incident osteoporotic fractures in RA is underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were from the Veterans Affairs (VA) Rheumatoid Arthritis Registry. Frailty was measured using the VA Frailty Index (VAFI). Incident osteoporotic fractures were identified by administrative codes and validated by physician chart review. Multivariable Cox proportional hazard models quantified the relationship between frailty category and incident osteoporotic fracture. Models adjusted for baseline age, sex, race, anti\u2010CCP positivity, prior fracture, body mass index, smoking status, disease duration, disease activity, prednisone use, and RA and osteoporosis medication use. Secondary analyses evaluated the relationships between each individual VAFI components and incident fracture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants (n = 2,912) had a mean age of 64.3 (11.0) years, 88% were men, 76% were White, and 248 (9%) had incident osteoporotic fractures. At baseline, 30% were robust, 38% prefrail, 18% mildly frail, 7% moderately frail, and 3% severely frail. Baseline frailty levels were associated with a significant stepwise increased risk in osteoporotic fracture risk when robust was used as the reference category (mild: adjusted hazard ratio [aHR] 2.02, 95% confidence interval [CI] 1.37\u20132.97; moderate: aHR 2.99, 95% CI 1.83\u20134.87; severe: aHR 4.67, 95% CI 2.41\u20139.03;\n                      <jats:italic>P<\/jats:italic>\n                      value for trend &lt;0.001). Functional deficits were the three of the top five contributors to the relationship between frailty and incident fracture: failure to thrive (aHR 4.57, 95% CI 1.10\u201318.94), muscular issues (aHR 2.42, 95% CI 1.69\u20133.4), and gait abnormality (aHR 2.01, 95% CI 1.39\u20132.93; all\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Frailty is associated with an increased risk of incident osteoporotic fracture in RA. Comparing the predictive ability of VAFI with other established fracture prediction models is needed to determine if it can be deployed to improve osteoporosis screening and treatment in this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.80107","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T12:35:28Z","timestamp":1782131728000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty Predicts Incident Osteoporotic Fractures in Veterans with Rheumatoid Arthritis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8707-7649","authenticated-orcid":false,"given":"Katherine D.","family":"Wysham","sequence":"first","affiliation":[{"name":"Veterans Affairs (VA) Puget Sound Healthcare System  Seattle Washington"},{"name":"University of Washington  Seattle"},{"name":"VA Puget Sound Geriatric Research Education and Clinical Center (GRECC)  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah F.","family":"Brubeck","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Puget Sound Healthcare System  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Baraff","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Puget Sound Healthcare System  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punyasha","family":"Roul","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-363X","authenticated-orcid":false,"given":"Namrata","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Andrews","sequence":"additional","affiliation":[{"name":"Birmingham VA Health Care System  Birmingham Alabama"},{"name":"University of Alabama at Birmingham"},{"name":"Birmingham\/Atlanta VA GRECC  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6640-9173","authenticated-orcid":false,"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"VA Salt Lake City  Salt Lake City Utah"},{"name":"University of Utah  Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary A.","family":"Kunkel","sequence":"additional","affiliation":[{"name":"VA Salt Lake City  Salt Lake City Utah"},{"name":"University of Utah  Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-2272","authenticated-orcid":false,"given":"Ted R.","family":"Mikuls","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"},{"name":"VA Nebraska\u2010Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9649-3588","authenticated-orcid":false,"given":"Bryant R.","family":"England","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center  Omaha"},{"name":"VA Nebraska\u2010Western Iowa Health Care System  Omaha Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores M.","family":"Shoback","sequence":"additional","affiliation":[{"name":"San Francisco VA Medical Center  San Francisco California"},{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8146-2519","authenticated-orcid":false,"given":"Patricia P.","family":"Katz","sequence":"additional","affiliation":[{"name":"University of California  San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Puget Sound Healthcare System  Seattle Washington"},{"name":"University of Washington  Seattle"},{"name":"VA Puget Sound Geriatric Research Education and Clinical Center (GRECC)  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela R.","family":"Orkaby","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts"},{"name":"Brigham and Women's Hospital Harvard Medical Center  Boston Massachusetts"},{"name":"VA New England GRECC  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua F.","family":"Baker","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia"},{"name":"Corporal Michael J. 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