The Prevalence of Vertebral Fractures in Spondyloarthropathies: Relation to Disease Characteristics, Bone Mineral Density, Syndesmophytes and History of Back Pain and Trauma

Abstract

Background An increased risk of vertebral fracture (VF) is one of the extra-articular manifestations of spondyloarthropathies (SpA). The prevalence of moderate/severe radiographic vertebral fractures in SpA in daily practice is unknown until imaging of the full spine is available, as most VFs do not present with the clinical signs and symptoms of an acute fracture.

Objectives The primary aim is to investigate the prevalence of VFs in SpA and the relation to clinical disease parameters.

Methods We evaluated the prevalence of VFs (>25% loss in height) on available radiographs of the thoracic and lumbar spine in 390 consecutive SpA patients in daily practice and their association with disease characteristics, bone mineral density (BMD), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and history of trauma.

Results Forty-eight patients (12.3%) had a VF, of whom 56.3% were men, 44.7% had multiple VFs, and 93.8% of VFs were located in the thoracic spine. Compared to patients without VF, patients with a VF were older (52.4 vs. 47.3 years, p<0.01, range 25-84 years), had a marginally lower femoral neck T-score (-1.0 vs. -0.7, p=0.06), more peripheral joint disease (4.4 vs. 3.5, p<0.05) and a higher mSASSS (11.8 vs. 7.0, p<0.05). Of patients with a VF, 14.6% had a history of trauma with acute back pain (p<0.01 vs. no VF).

Conclusions Moderate to severe vertebral fractures are found in more than 10% of SpA patients, already from the age of 25 years on. Most VFs are located in the thoracic region, are related to low femoral neck BMD and to stiffening of the spine, and are only in one out of six patients related to trauma history.