{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T02:07:54Z","timestamp":1773194874509,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hip fractures are among the most devastating complications of osteoporosis, yet determinants of the Fracture Risk Assessment Tool (FRAX)\u2013estimated 10-year hip fracture probability (FRAX-Hip) in rheumatoid arthritis (RA) remain incompletely defined. The incremental value of RA disease activity and complete blood count (CBC)\u2013derived inflammatory indices beyond traditional FRAX clinical risk factors is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify determinants of 10-year FRAX-Hip risk in RA and to compare the predictive performance and incremental value of RA disease activity indices and CBC-derived inflammatory markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a cross-sectional cohort of 248 RA patients undergoing dual-energy X-ray absorptiometry, we calculated femoral neck bone mineral density (BMD)\u2013adjusted FRAX-Hip and defined high risk as FRAX-Hip \u22653%. Determinants were assessed using Firth penalized logistic regression and multivariable linear regression, and incremental value was evaluated using changes in area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High FRAX-Hip risk was mainly driven by older age, female sex, lower body mass index, glucocorticoid exposure, and lower femoral neck BMD. Among disease activity measures, the Simplified Disease Activity Index (SDAI) provided the largest\u2014yet modest\u2014incremental improvement over a base clinical model (\u0394AUC = 0.013; NRI = 0.903; IDI = 0.075). In contrast, CBC-derived inflammatory indices showed poor discrimination (AUC 0.46\u20130.62) and negligible incremental value. The clinical model explained &amp;gt;93% of the variance in log-transformed FRAX-Hip.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Traditional FRAX clinical factors dominate FRAX-Hip risk estimation in RA. SDAI adds only modest incremental value, whereas CBC-derived indices do not improve risk stratification. FRAX with BMD remains a robust tool for identifying high-risk patients, underscoring the importance of optimizing age-, glucocorticoid-, and bone density\u2013related risk factors while maintaining tight RA disease control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1762448","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T05:29:27Z","timestamp":1773120567000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Traditional clinical risk factors outperform disease activity and hematologic indices for FRAX hip fracture risk in rheumatoid arthritis"],"prefix":"10.3389","volume":"17","author":[{"given":"Lina","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuwei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency Internal Medicine, Weifang People\u2019s Hospital","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Weifang People\u2019s Hospital","place":["Weifang, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng-Guang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Weifang People\u2019s Hospital","place":["Weifang, Shandong, 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