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Background <p><?tk 3?>Rheumatoid arthritis (RA) is a systemic inflammatory disease where osteoporosis and fragility fractures represent severe comorbidities. Conventional inflammatory markers like C-reactive protein (CRP) often fail to adequately stratify skeletal risk. This study aimed to investigate whether novel, composite inflammatory indices, derived from routine blood tests, are more strongly associated with osteoporosis and fracture history in patients with RA.</p> Methods <p>In this cross-sectional study of 439 RA patients, we analyzed clinical data and a panel of inflammatory markers. Patients were stratified by bone mineral density (BMD). Correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analyses were used to identify factors associated with osteoporosis and fracture risk.</p> Results <p>Osteoporosis was diagnosed in 55.4% of patients. A distinct inflammatory gradient was observed across BMD categories, with novel composite indices, including the CRP-to-lymphocyte ratio (CLR) and Inflammation Burden Index (IBI), demonstrating a more robust increase than conventional markers (P for trend &lt; 0.001). The ROC analysis confirmed the modest discriminative ability of the CRP-based composite indices for osteoporosis, with AUC values of CLR = 0.607 (95% CI: 0.554–0.660) and IBI = 0.591 (95% CI: 0.537–0.64), compared to the cell-ratio markers. Older age, diagnostic delay, and lower hemoglobin were associated with osteoporosis. Critically, patients with a fracture history (41.2% in the osteoporosis group) had markedly elevated CLR and IBI levels, which showed modest predictive value for fractures, with AUC values of 0.593 (95% CI: 0.532–0.655) for CLR and 0.581 (95% CI: 0.519–0.643) for IBI.</p> Conclusions <p>Novel composite inflammatory indices, particularly CLR and IBI, are associated with low bone density and fragility fracture history. These easily calculated markers may provide cost-effective, complementary information when used alongside other clinical factors for assessing inflammation-related skeletal risk in RA patients.</p>

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Inflammation-related composite indices and their association with osteoporosis and fragility fractures in rheumatoid arthritis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Yutong Jiang,
  • Lingmin Su,
  • Xiaoyi Zhao,
  • Xinlei Jia,
  • Wenyu Xu,
  • Bojin Chen,
  • Lingying Xu,
  • Baolin Zheng,
  • Jieruo Gu,
  • Mingcan Yang,
  • Qihong Guo,
  • Weifeng Ni

摘要

Background

Rheumatoid arthritis (RA) is a systemic inflammatory disease where osteoporosis and fragility fractures represent severe comorbidities. Conventional inflammatory markers like C-reactive protein (CRP) often fail to adequately stratify skeletal risk. This study aimed to investigate whether novel, composite inflammatory indices, derived from routine blood tests, are more strongly associated with osteoporosis and fracture history in patients with RA.

Methods

In this cross-sectional study of 439 RA patients, we analyzed clinical data and a panel of inflammatory markers. Patients were stratified by bone mineral density (BMD). Correlation, multivariate logistic regression, and receiver operating characteristic (ROC) curve analyses were used to identify factors associated with osteoporosis and fracture risk.

Results

Osteoporosis was diagnosed in 55.4% of patients. A distinct inflammatory gradient was observed across BMD categories, with novel composite indices, including the CRP-to-lymphocyte ratio (CLR) and Inflammation Burden Index (IBI), demonstrating a more robust increase than conventional markers (P for trend < 0.001). The ROC analysis confirmed the modest discriminative ability of the CRP-based composite indices for osteoporosis, with AUC values of CLR = 0.607 (95% CI: 0.554–0.660) and IBI = 0.591 (95% CI: 0.537–0.64), compared to the cell-ratio markers. Older age, diagnostic delay, and lower hemoglobin were associated with osteoporosis. Critically, patients with a fracture history (41.2% in the osteoporosis group) had markedly elevated CLR and IBI levels, which showed modest predictive value for fractures, with AUC values of 0.593 (95% CI: 0.532–0.655) for CLR and 0.581 (95% CI: 0.519–0.643) for IBI.

Conclusions

Novel composite inflammatory indices, particularly CLR and IBI, are associated with low bone density and fragility fracture history. These easily calculated markers may provide cost-effective, complementary information when used alongside other clinical factors for assessing inflammation-related skeletal risk in RA patients.