Osteoporosis International

, Volume 27, Issue 8, pp 2525–2531 | Cite as

Bone involvement in adult patients affected with Ehlers-Danlos syndrome.

  • C. Eller-Vainicher
  • A. Bassotti
  • A. Imeraj
  • E. Cairoli
  • F. M. Ulivieri
  • F. Cortini
  • M. Dubini
  • B. Marinelli
  • A. Spada
  • I. ChiodiniEmail author
Original Article



The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients.


The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients.


Fifty consecutive Caucasian patients, aged 30–50 years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects’ calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed.


Patients showed reduced BMD (Z-scores LS −0.45 ± 1.00, FN −0.56 ± 1.01, FT −0.58 ± 0.92) and TBS (1.299 ± 0.111) and increased prevalence of morphometric VFx (32 %) than controls (Z-scores LS 0.09 ± 1.22, FN 0.01 ± 0.97, FT 0.08 ± 0.89; TBS 1.382 ± 0.176; VFx 8 %, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245 ± 0.138 vs 1.325 ± 0.086, p < 0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency.


EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.


Bone quality Ehlers-Danlos syndrome Trabecular bone score Vertebral fractures 


Compliance with ethical standards

All subjects gave their witnessed informed consent before entering the study, which was approved by the Ethical Committee of our Hospital and in accordance with Helsinki Declaration II.


Funding is not applicable in this study.

Conflict of Interest


Supplementary material

198_2016_3562_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Unit of Occupational MedicineFondazione IRCCS Cà Granda-Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Department of Medical Sciences and Community HealthUniversity of MilanMilanItaly
  4. 4.Nuclear medicineFondazione IRCCS Cà Granda-Ospedale Maggiore PoliclinicoMilanItaly

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