MedWire News: Patients with early spondylarthropathies (SpA) have a high frequency of vertebral fractures and a low BMD, shows research published in the journal Osteoporosis International.
Mignon Van der Weijden from the University Medical Center in Amsterdam, The Netherlands, and team, found that vertebral fractures are going 'unrecognized' and untreated in SpA patients.
Vertebral fracture is known to be a common complication in patients with ankylosing spondylitis, but this condition is only one of many SpA diseases.
Therefore the researchers, looked at vertebral fracture risk in early SpA in 113 patients with undifferentiated spondylarthropathy (11%), SpA and inflammatory bowel disease (4%), reactive arthritis (4%), psoriatic arthritis (9%), and juvenile spondylarthropathy (1%), in addition to those with ankylosing spondylitis (71%).
The patient group had a median SpA disease duration of 7 months and a mean age of 37 years.
The researchers found that 15% of the patients had at least one vertebral fracture, and 3% had two fractures. Patients with vertebral fracture were significantly more likely to have low bone mineral density (BMD) at the lumbar spine and the presence of axial psoriatic arthritis than those without fractures.
Although eight patients were diagnosed with osteoporosis of the hip or spine, only 7%of the 17 patients with vertebral fractures were classed as osteoporotic, and this was not significant.
However, 38% of patients were classified as having osteopenia, so that altogether 45% of patients had low BMD, rising to 59% of patients with vertebral fracture.
"Interestingly, these fractures were predominantly located at the same parts of the spine as in typical osteoporotic fractures: the mid and low thoracic spine," say the authors, "which also suggests a role for underlying osteoporosis in these patients."
All fractures were low grade (grade 1 or 2) which suggests that such fractures occur at an early stage of SpA disease, while high-grade fractures are more common later in disease progression.
The researchers conclude that vertebral fractures are common in early SpA patients and developing treatment could be a challenge for future research.
"Vertebral fractures have been associated with more back pain, reduced quality of life, and increased risk of future vertebral and non-vertebral fractures, which stresses the importance of recognition of these fractures in daily practice also in early stage of disease," Van der Weijden and co-workers say.
However, the authors recognize the study's limitations, namely the lack of an age- and gender-matched control group.
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