WASHINGTON, DC — Arthritis is a common chronic condition that increases with age, but it may pose greater health risks than previously recognized, particularly for those who did not serve in the military, a new study has suggested.
The study analyzed data from 135,000 women followed for more than 16 years as part of the Women’s Health Initiative (WHI). Roughly half of postmenopausal women (53.8% of veterans and 47.4% of nonveterans) had arthritis at the time of enrollment. Although participants were asked if they had rheumatoid arthritis (RA) or osteoarthritis (OA), because of limited sample size, RA and OA groups were distinguished for descriptive purposes only.1
Using logistic regression, Cox regression and multistate Markov modeling to investigate the impact of arthritis on other health outcomes, researchers found that, for nonveteran women, arthritis was linked to an 8% higher risk of cardiovascular disease and a 3% higher risk of all-cause mortality. Arthritis was not associated with an increased risk of bone fracture in either group, however, VA research health science specialist Hind A Beydoun, PhD, and colleagues reported in GeroScience.
The study also examined transitions between six health states—ranging from healthy to CVD, bone fracture and death. Notably, the probability of transitioning from bone fracture to death was higher among women with arthritis, particularly nonveterans.
Veterans Showed Different Patterns
Although the raw data suggested higher arthritis rates in veterans, that relationship disappeared after adjusting for demographic, lifestyle and health characteristics. “After adjusting for these characteristics, veteran status was not related to prevalent arthritis,” the researchers reported.
But veteran and non-veteran women did show different patterns when it came to how arthritis influenced health trajectories over time. The researchers found a significant interaction between arthritis status and veteran status in predicting mortality following bone fracture. This suggests that veterans may have some degree of protection or resilience in the face of adverse health outcomes—a finding that may reflect what’s known as the “healthy soldier effect.”
“[V]eteran women may exhibit resilience against poor prognosis after a bone fracture possibly because of a phenomenon referred to as the “healthy soldier effect”—lower morbidity and mortality risks among active duty and retired military personnel compared to the general population—or because of better lifestyle, including diet and physical activity, among veteran vs. non-veteran postmenopausal women potentially counteracting the adverse health consequences of arthritis,” the researchers wrote.
The groups might differ from each other “in terms of behaviors (alcohol consumption, physical activity, sedentary time, depressive symptoms, sleep), symptoms (fatigue, pain, vasomotor symptoms), as well as morbidity (diabetes CVD, bone density and fracture, physical function, cognitive function, successful, effective, and optimal aging), and mortality outcomes, as reported in previous analyses of WHI data,” they wrote.
“Furthermore, it is plausible that a better health profile among veterans may be protective against transitions observed among non-veterans, although it is also plausible that veterans have other vulnerabilities that may outweigh the impact of arthritis on these transitions, especially with respect to prognosis after bone fracture,” the researchers continued.
Limitations and Future Directions
The study has several limitations. Because it analyzed a subset of WHI participants who volunteered and met certain eligibility criteria, results may not generalize to younger or more racially and ethnically diverse women. In addition, much of the data was self-reported, and the number of veterans in the study (3,436) was small compared to the nonveteran group (132,354), which could affect the statistical power of certain comparisons.
Despite these caveats, the researchers say their findings highlight important clinical implications—particularly the need for targeted prevention strategies and cardiovascular monitoring in postmenopausal women with arthritis.
As the number of women veterans continues to rise, understanding how their health profiles differ from civilian women has become more urgent. “Women currently constitute the fastest growing segment among military veterans in the US,” the researchers noted, adding that veterans and non-veterans “differed by demographic, socioeconomic, lifestyle, and health characteristics.”
Ultimately, the study reinforced the idea that arthritis is not a one-size-fits-all condition. “Veteran and non-veteran women differed by… risk/protective characteristics,” the researchers observed. That means clinical care and prevention strategies may need to be tailored, not only by age and gender, but by life history—including military service.
“Larger studies are needed that can disentangle the respective roles of RA and OA in different CVD and bone fracture subtypes as well as all-cause mortality risks among veteran and non-veteran postmenopausal women,” the authors concluded.
More Prevalent in Veterans
In general, arthritis is more prevalent in veterans, according to a 2023 report from the national Centers for Disease Control and Prevention.
An article in the Morbidity & Mortality Weekly Report noted that arthritis prevalence is higher among U.S. military veterans. The national Centers for Disease Control and Prevention analyzed pooled 2017-2021 Behavioral Risk Factor Surveillance System data to estimate the prevalence of diagnosed arthritis among veterans and nonveterans, stratified by sex and selected demographic characteristics.2
The results indicated that about one-third of veterans had diagnosed arthritis (unadjusted prevalence = 34.7% [men] and 31.9% [women]). Among men aged 18-44 years, arthritis prevalence among veterans was double that of nonveterans (prevalence ratio [PR] = 2.1; 95% CI = 1.9–2.2), and among men aged 45–64 years, arthritis prevalence among veterans was 30% higher than that among nonveterans (PR = 1.3; 95% CI = 1.3–1.4).
Among women aged 18-44 years, arthritis prevalence among veterans was 60% higher than that among nonveterans (PR = 1.6; 95% CI = 1.4-1.7); among women aged 45–64 years, arthritis prevalence among veterans was 20% higher than that among nonveterans (PR = 1.2; 95% CI = 1.1–1.3).
“Cultivating partnerships with veteran-serving organizations to promote or deliver arthritis-appropriate interventions might be advantageous, especially for states where arthritis prevalence among veterans is highest,” the authors wrote. “The high prevalence of arthritis among female veterans, veterans aged ≥65 years, and veterans with disabilities highlights the importance of ensuring equitable access and inclusion when offering arthritis-appropriate interventions.”
- Beydoun HA, Beydoun MA, Weiss J, Brunner R, et al. Cardiovascular disease, bone fracture, and all-cause mortality risks among postmenopausal women by arthritis and veteran status: A multistate Markov transition analysis. Geroscience. 2025 Jan 29. doi: 10.1007/s11357-025-01527-7. Epub ahead of print. PMID: 39875753.
- Fallon EA, Boring MA, Foster AL, Stowe EW, Lites TD, Allen KD. Arthritis Prevalence Among Veterans – United States, 2017-2021. MMWR Morb Mortal Wkly Rep. 2023 Nov 10;72(45):1209-1216. doi: 10.15585/mmwr.mm7245a1. PMID: 37943702; PMCID: PMC10651321.
