A consecutive 2-year increase in the modified health assessment questionnaire score is associated with subsequent fractures in patients with rheumatoid arthritis

Objectives Rheumatoid arthritis (RA) is a well-recognised risk factor for fractures. However, short-term fracture risk factors remain unclear. This study aimed to elucidate factors useful for short-term fracture prevention. Methods Patients were enrolled in the National Database of Rheumatic Diseases in Japan (2002–2020) were analysed. Modifiable risk factors included changes in disease activity, modified health assessment questionnaire (mHAQ) scores and oral glucocorticoid usage. Results Of the 37,466 patients with RA enrolled, 1655 experienced a first fracture. Sex, age, disease duration, disease activity, mHAQ score and glucocorticoid usage significantly differed between patients with and without fractures. Among 734 with 4-year pre-fracture data, mHAQ scores gradually increased over consecutive years before the fracture. When classified into four groups according to mHAQ changes over 2 consecutive years, patients with continuous increases had significantly higher fracture incidence (2.13%) than those with increases only in years 1–2 (1.43%), only in years 2–3 (1.59%) or with no increase across 2 consecutive years). Conclusions A consecutive 2-year increase in mHAQ score is associated with an increased risk of subsequent fracture in patients with RA, offering valuable insight for targeted fracture prevention strategies.