This prospective cohort study (QUALYOR) followed 1,180 postmenopausal women ≥50 years for a mean of 4.6 years to examine whether erosive hand osteoarthritis (ErHOA) at baseline was associated with incident osteoporotic fractures and bone loss, compared to symptomatic HOA (SHOA) and no HOA.
ErHOA was associated with nearly double the risk of incident osteoporotic fracture vs. no HOA (HR 1.9, 95% CI 1.09–3.3); standardized incidence rates were 58.5 vs. 30.2 per 1,000 person-years. No significant fracture risk elevation was seen with SHOA. Path analysis suggested the association was independent of bone loss over time.
- Relatively small ErHOA subgroup (n=141, 11.9%) limits statistical precision (wide CIs). - Path analysis exploring mechanisms was exploratory only, not confirmatory. - Follow-up was ~4.6 years; longer observation may be needed to capture full fracture burden.
Postmenopausal women with erosive hand OA should prompt heightened fracture risk assessment, independent of standard bone density findings. Consider formal osteoporosis workup and fracture prevention strategies in this group, even when DXA results appear reassuring.
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