Spondyloarthropathies: Look Early for Fractures in Men

ROME — Osteoporotic vertebral fractures are recognized to be a common and serious complication of longstanding spondyloarthropathies, but vertebral fractures also proved unexpectedly common in a series of recently diagnosed patients.

In 113 patients with a median disease duration of just 6.9 months, spinal x-rays revealed that 15% already had asymptomatic vertebral fractures, mainly located in the midthoracic region at T6-T8.

Three patients had two vertebral fractures, Dr. Irene E. van der Horst-Bruinsma reported.

These findings constitute a strong argument for obtaining routine screening with spinal x-rays at the time of diagnosis of ankylosing spondylitis and other spondyloarthropathies, according to Dr. Horst-Bruinsma of VU University Medical Center, Amsterdam.

“These are relatively young patients with a mean age of 38 years, mostly male, so this is a surprisingly high rate of vertebral fractures that were totally asymptomatic.

“We would not have found them if we had not routinely taken x-rays,” she noted in an interview.

Three of 11 patients with axial psoriatic arthritis had prevalent vertebral fractures. This translated to a 4.6-fold increased risk, compared with the overall group of early spondyloarthropathy patients.

The explanation for the high rate of vertebral fractures in this subgroup is unknown, Dr. Horst-Bruinsma said.

Patients with vertebral fractures had lower bone mineral density at the lumbar spine than did those without fractures, but BMD was still within normal range.

And the fracture patients' BMD at the hip was essentially the same as in patients without vertebral fractures.

Dr. Horst-Bruinsma said that finding a vertebral fracture in a patient with an early spondyloarthropathy lowers her personal clinical threshold for initiating therapy with a biologic anti–tumor necrosis factor agent.

“That's the only treatment that might reduce their now-increased likelihood of further, more serious fractures.

TNF blocker therapy has been shown to increase bone mineral density at the spine, and therapy with these agents has an anti-inflammatory effect.

It's not proven that anti-TNF therapy will prevent subsequent fractures, but it's a testable hypothesis,” she said.

Disclosures: The study was funded by the Jan van Breemen Institute. Dr. Horst-Bruinsma disclosed having no financial conflicts.