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Prevalent vertebral fractures incur high risk of future fractures in inflammatory myositis

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Abstract

Objective

To assess accrual of new vertebral fractures (VF) in patients with idiopathic inflammatory myositis (IIM) over a period of time.

Methods

Hundred patients who were previously enrolled for a cross-sectional study on prevalence of asymptomatic VF were telephonically requested to review with repeat spinal radiographs and dual-energy X-ray absorptiometry (DEXA) after 3 years. Radiographs were scored using Genant’s semi-quantitative technique. Disease activity and damage were assessed by myositis damage index (MDI) extent of damage and modified MDI for which the osteoporotic fracture item in MDI was removed. VF progressors were compared with non-progressors.

Results

Of 31 patients reviewed, 11 had dermatomyositis, 8 polymyositis, and 6 each overlap and anti-synthetase syndrome. Eighteen patients underwent DEXA scan. Seventeen had VF at baseline. At 91.62 patient years of follow-up, total number of VF increased from 27 to 51. Patients who had previous VF had higher risk of developing a new VF when compared with those with no VF (76.5% vs. 14.28%, RR: 5.35). Patients with old VF accrue fractures at a rate of 26.2 per 100 patient years. The number of fractures correlated significantly with age, T scores at the L4 level, and lower third of radius on DEXA, MDI, and modified MDI. Neither conventional nor disease-related variables differed between progressors and non-progressors.

Conclusion

Patients with IIM with a prior VF incurred a five times risk of subsequent VF irrespective of disease activity and glucocorticoids.

Key Points

• Patients with inflammatory myositis are at a high risk of asymptomatic vertebral fractures.

• Patients with baseline vertebral fractures incur a high risk of future fractures on follow-up.

• Number of fractures is negatively correlated with age, BMD values at lower end of radius, L4, and damage.

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Acknowledgements

We would like to thank the Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, for helping with bone mineral density assessments for these patients.

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Authors and Affiliations

  1. Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Sujata Ganguly, Able Lawrence & Latika Gupta

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  1. Sujata Ganguly
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  2. Able Lawrence
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  3. Latika Gupta
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Contributions

LG conceptualised and designed the study. LG and SG recruited the patients. Radiograph readings were done by LG and AL. Manuscript was written by SG and LG. All three reviewed the final manuscript and gave their approval.

Corresponding author

Correspondence to Latika Gupta.

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Abstracts of scientific contributions to GCOM 2019. BMC Rheumatol 3, 31 (2019)

Abstract No. P29.

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Ganguly, S., Lawrence, A. & Gupta, L. Prevalent vertebral fractures incur high risk of future fractures in inflammatory myositis. Clin Rheumatol 40, 1431–1436 (2021). https://doi.org/10.1007/s10067-020-05365-0

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  • DOI: https://doi.org/10.1007/s10067-020-05365-0

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