Supplementary Material for: Incidence of Osteoporotic Fractures in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract
Introduction
Although patients with rheumatoid arthritis (RA) have a high risk for osteoporosis (OP), updated evidence on the incidence of osteoporotic fractures (OPF) is needed. This meta-analysis aimed to quantify the risk of incident OPF in patients with RA compared to non-RA controls and to examine this risk stratified by sex.
Methods
We searched PubMed, Web of Science, Embase, and Cochrane Library databases until October 22, 2025, for cohort studies that compared the incidence of fractures in adults with RA with that in a control group without RA. Two authors independently conducted the study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. After screening 12,408 records, seven cohort studies were included. Risk Ratios (RR) with 95% confidence intervals (CI) were pooled to estimate the overall risk.
Results
From a total of 12,408 records identified through database searching, seven cohort studies were included in the final analysis. The pooled results demonstrated that RA was significantly associated with an increased risk of OPF, with a RR of 1.47 (95% CI: 1.32–1.64, P < 0.00001). Subgroup analysis by sex further revealed an elevated risk in both female (RR = 1.39, 95% CI: 1.30–1.49) and male patients with RA (RR = 1.69, 95% CI: 1.44–1.97) compared to their respective non-RA control groups.
Conclusion
Individuals with RA have a significantly higher risk of developing OPF compared to those without RA.