Researchers also looked at whether participants were diagnosed with RA when they were younger or older than 50. They found that, no matter their age at diagnosis, both men and women with RA were at higher risk of fracture than people without RA. Among the men, those with RA had an increased risk of fracture when they were older compared with those who didn’t have RA. The group younger than 50 with fractures was too small to draw a conclusion.

But among women with RA, the increased risk of fracture was apparent even when they were younger than 50. In fact, women younger than 50 with RA were almost twice as likely to have any fracture and almost five times more likely to suffer an osteoporotic fracture compared to their counterpart without RA.

Why this increased risk? “The disease itself appears to be a risk factor for fracture,” explains Dr. Amin. “Also, because of the disease, if they are not as active or have difficulty with ambulation they could put themselves at risk of falling. And diminished activity itself could be a contributing factor to bone loss.”

Another risk factor could be corticosteroid use, which is known to cause bone loss; 60 to 70 percent of the RA subjects were on some form of steroids during the course of their illness, she notes. But steroid use as a risk factor is not so cut-and-dried. “Steroids can also be preventative [of fractures] by decreasing inflammation and controlling disease – but we couldn’t tease that out,” says Dr. Amin.

Dr. Amin says in the future they will look at the RA population to see if they can identify the reasons behind the higher fracture risk.

“It is important when diagnosing RA in women at younger ages for physicians to be aware of fracture risk,” says Joanne Jordan, MD, chief of the division of rheumatology, allergy and immunology at the University of North Carolina School of Medicine, in Chapel Hill. “Fracture is not usually high on the list of worries. We need to pay attention to this, because it is not uncommon for young women with RA to be treated with corticosteroids, which can affect bones. We need to make sure our patients are taking preventive measures and that they think about this risk as well.”