Osteoporosis International

, Volume 23, Issue 6, pp 1683–1690 | Cite as

High frequency of vertebral fractures in early spondylarthropathies

  • M. A. C. van der Weijden
  • I. E. van der Horst-Bruinsma
  • J. C. van Denderen
  • B. A. C. Dijkmans
  • M. W. Heymans
  • W. F. Lems
Original Article



We demonstrated that vertebral fractures (VF) are commonly found in early SpA. Patients with VF had lower lumbar BMD than patients without VF. VF remained frequently ‘unrecognized’ and untreated. VF have been associated with more back pain, reduced Qol, and increased risk of future fractures which stresses the importance of recognition also in early stage SpA.


VF are a common complication of long-standing ankylosing spondylitis (AS). However, data of VF in early AS patients and in other spondylarthropathies (SpA) are scarce. Therefore we examined the prevalence of VF in early SpA patients and investigated the associations between VF and demographic and disease-related variables.


SpA patients were included consecutively and radiographs of the spine were made. VF were assessed according to the method of Genant et al.: fractures were defined as reduction of ≥20% of the vertebrae. Descriptive statistics, t-tests and logistic regression analyses were used to study the relationship between VF and demographic and disease-related variables, radiographic damage and BMD.


A total of 113 early SpA patients were included with a disease duration of 7 months, a mean age of 37 years. Seventeen patients (15%) had at least one VF. Fourteen patients had one VF, three patients had two VF. Most VF were located at Th6–Th8. In patients with VF, bone mineral density (BMD) of lumbar spine was lower than BMD of patients without VF (t-test: p = 0.043). Axial Psoriatic Arthritis (PsA) was significantly associated with a higher risk for VF (odds ratio [OR]: 4.62, 95% confidence interval [CI] 1.15–18.58, p = 0.031). No significant associations were found with disease activity variables nor with radiographic severity.


In a group of 113 early, young SpA patients, 15% already had at least one VF. Most VF were asymptomatic, undetected by routine diagnostic procedures and located at the mid-thoracic spine. The VF were associated with low BMD of the lumbar spine and with axial PsA.


Ankylosing spondylitis Bone mineral density Osteoporosis Spondylarthropathies Vertebral fractures 


Conflicts of interest



  1. 1.
    Bessant R, Keat A (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29:1511–1519PubMedGoogle Scholar
  2. 2.
    El Maghraoui A, Borderie D, Cherruau B, Edouard R, Dougados M, Roux C (1999) Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 26:2205–2209PubMedGoogle Scholar
  3. 3.
    Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford) 39:85–89CrossRefGoogle Scholar
  4. 4.
    Will R, Palmer R, Bhalla AK, Ring F, Calin A (1989) Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet 2:1483–1485PubMedCrossRefGoogle Scholar
  5. 5.
    Karberg K, Zochling J, Sieper J, Felsenberg D, Braun J (2005) Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 32:1290–1298PubMedGoogle Scholar
  6. 6.
    Altenbernd J, Bitu S, Lemburg S, Peters S, Seybold D, Meindl R et al (2009) Vertebral fractures in patients with ankylosing spondylitis: a retrospective analysis of 66 patients. Rofo 181:45–53PubMedCrossRefGoogle Scholar
  7. 7.
    Vosse D, Feldtkeller E, Erlendsson J, Geusens P, van der Linden S (2004) Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheumatol 31:1981–85PubMedGoogle Scholar
  8. 8.
    Cooper C, Carbone L, Michet CJ, Atkinson EJ, O'Fallon WM, Melton LJ III (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21:1877–1882PubMedGoogle Scholar
  9. 9.
    van der Weijden MA, van Denderen JC, Lems WF, Heymans MW, Dijkmans BA, van der Horst-Bruinsma IE (2011) Low bone mineral density is related to male gender and decreased functional capacity in early spondylarthropathies. Clin Rheumatol 30:497–503PubMedCrossRefGoogle Scholar
  10. 10.
    Briggs AM, Greig AM, Wark JD (2007) The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int 18:575–584PubMedCrossRefGoogle Scholar
  11. 11.
    Schuit SC, van der KM, Weel AE, de Laet CE, Burger H, Seeman E et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34:195–202Google Scholar
  12. 12.
    Lems WF (2007) Clinical relevance of vertebral fractures. Ann Rheum Dis 66:2–4PubMedCrossRefGoogle Scholar
  13. 13.
    Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237:2613–2614PubMedCrossRefGoogle Scholar
  14. 14.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227PubMedCrossRefGoogle Scholar
  15. 15.
    Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  16. 16.
    Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285PubMedGoogle Scholar
  17. 17.
    Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698PubMedGoogle Scholar
  18. 18.
    Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL (2005) Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 64:127–129PubMedCrossRefGoogle Scholar
  19. 19.
    WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129Google Scholar
  20. 20.
    Genant HK, Wu CY, van KC, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–11348PubMedCrossRefGoogle Scholar
  21. 21.
    El Maghraoui A (2004) Osteoporosis and ankylosing spondylitis. Joint Bone Spine 71:291–295PubMedCrossRefGoogle Scholar
  22. 22.
    Ghozlani I, Ghazi M, Nouijai A, Mounach A, Rezqi A, Achemlal L et al (2009) Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 44:772–776PubMedCrossRefGoogle Scholar
  23. 23.
    Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53:117–121PubMedCrossRefGoogle Scholar
  24. 24.
    Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH (2007) Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis 66:633–638PubMedCrossRefGoogle Scholar
  25. 25.
    Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157PubMedCrossRefGoogle Scholar
  26. 26.
    Montala N, Juanola X, Collantes E, Munoz-Gomariz E, Gonzalez C, Gratacos J et al (2011) Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis. J Rheumatol 38:893–897PubMedCrossRefGoogle Scholar
  27. 27.
    Vosse D, Landewe R, van der Heijde D, van der Linden S, van Staa TP, Geusens P (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 68:1839–1842PubMedCrossRefGoogle Scholar
  28. 28.
    Harrison BJ, Hutchinson CE, Adams J, Bruce IN, Herrick AL (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61:1007–1011PubMedCrossRefGoogle Scholar
  29. 29.
    Borman P, Babaoglu S, Gur G, Bingol S, Bodur H (2008) Bone mineral density and bone turnover in patients with psoriatic arthritis. Clin Rheumatol 27:443–447PubMedCrossRefGoogle Scholar
  30. 30.
    Frediani B, Allegri A, Falsetti P, Storri L, Bisogno S, Baldi F et al (2001) Bone mineral density in patients with psoriatic arthritis. J Rheumatol 28:138–143PubMedGoogle Scholar
  31. 31.
    Dheda K, Cassim B, Patel N, Mody GM (2004) A comparison of bone mineral density in Indians with psoriatic polyarthritis and healthy Indian volunteers. Clin Rheumatol 23:89PubMedCrossRefGoogle Scholar
  32. 32.
    Grisar J, Bernecker PM, Aringer M, Redlich K, Sedlak M, Wolozcszuk W et al (2002) Ankylosing spondylitis, psoriatic arthritis, and reactive arthritis show increased bone resorption, but differ with regard to bone formation. J Rheumatol 29:1430–1436PubMedGoogle Scholar
  33. 33.
    Nolla JM, Fiter J, Rozadilla A, Gomez-Vaquero C, Mateo L, Rodriguez-Moreno J et al (1999) Bone mineral density in patients with peripheral psoriatic arthritis. Rev Rhum Engl Ed 66:457–461PubMedGoogle Scholar
  34. 34.
    Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK (2003) Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 12(Suppl 2):S104–S112PubMedCrossRefGoogle Scholar
  35. 35.
    Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D et al (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587PubMedCrossRefGoogle Scholar
  36. 36.
    Geusens P, Vosse D, van der Linden S (2007) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19:335–339PubMedCrossRefGoogle Scholar
  37. 37.
    Lentle BC, Brown JP, Khan A, Leslie WD, Levesque J, Lyons DJ et al (2007) Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures. Can Assoc Radiol J 58:27–36PubMedGoogle Scholar
  38. 38.
    Naves M, az-Lopez JB, Gomez C, Rodriguez-Rebollar A, Rodriguez-Garcia M, Cannata-Andia JB (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–5524PubMedCrossRefGoogle Scholar
  39. 39.
    Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828PubMedCrossRefGoogle Scholar
  40. 40.
    Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68PubMedCrossRefGoogle Scholar
  41. 41.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • M. A. C. van der Weijden
    • 1
    • 2
  • I. E. van der Horst-Bruinsma
    • 1
  • J. C. van Denderen
    • 2
  • B. A. C. Dijkmans
    • 1
    • 2
  • M. W. Heymans
    • 3
  • W. F. Lems
    • 1
    • 2
  1. 1.Department of RheumatologyVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of RheumatologyReadeAmsterdamThe Netherlands
  3. 3.Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamThe Netherlands

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