Vertebral Fractures in 10% of Spondyloarthritis Patients Save

Vertebral fractures are not uncommon in patients with ankylosing spondylitis and spondyloarthritis. However, they may be difficult to diagnose as they may not present with typical features of an acute fracture, may be overlooked as a disease flare of spondylitis or may only be incidentally found on unrelated imaging studies.

Investigators from Belgium and the Netherlands assessed 390 consecutive spondyloarthritis patients for vertebral fractures using DXA scans and radiographs. (Citation source: http://buff.ly/1N1B0Cd)

Those enrolled included 175 (44.9 %) men and 215 (55.1 %) women, with a mean age of 47.9 yrs. They had a symptom duration of 14.6 yrs. and diagnosis duration of 10.8 yrs. The group included patients with AS (73.3%), PsA (10.3%), IBD (4.6%), and undifferentiated SpA (11.8%).

Forty-six patients (11.8 %) had vertebral fractures. Rates rose with age and were more likely in men than women. The majority of these (93.5%) were thoracic fractures and 44.5% had multiple vertebral fractures. The prevalence was highest in IBD (22.2 %), followed by 12.2 % in AS and 10.0 % in PsA, and lowest in undifferentiated SpA (6.5 %).

Patients with verterbral fratures were significantly older (52.2 vs. 47.3 yrs.), had lower femoral neck T-scores, a prior history of trauma with acute back pain and had a marginally higher modified Stoke Ankylosing Spondylitis Spinal Score (11.7 vs. 7.0; p = 0.06). Moderate to severe vertebral fractures were found in >10 % of SpA patients under age 40 years (5 % of women and 9 % in men).

Most verterbral fractures are found in the thoracic region, and were related to low femoral neck bone density, but only rarely related to trauma history. DXA proved to be a useful alternative for diagnosing verterbral fractures.