Ankylosing spondylitis confers substantially increased risk of clinical spine fractures: a nationwide case-control study
- 24 October 2014
- journal article
- research article
- Published by Springer Science and Business Media LLC in Osteoporosis International
- Vol. 26 (1), 85-91
- https://doi.org/10.1007/s00198-014-2939-3
Abstract
Ankylosing spondylitis (AS) leads to osteopenia/osteoporosis and spine rigidity. We conducted a case-control study and found that AS-affected patients have a 5-fold and 50% increased risk of clinical spine and all clinical fractures, respectively. Excess risk of both is highest in the first years and warrants an early bone health assessment after diagnosis. Ankylosing spondylitis (AS) is related to spine rigidity and reduced bone mass, but data on its impact on fracture risk are scarce. We aimed to study the association between AS and clinical fractures using a case-control design. From the Danish Health Registries, we identified all subjects who sustained a fracture in the year 2000 (cases) and matched up to three controls by year of birth, gender and region. Clinically diagnosed AS was identified using International Classification of Diseases, 8th revision (ICD-8; 71249), and International Classification of Diseases, 10th revision (ICD-10; M45) codes. We also studied the impact of AS duration. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) for non-traumatic fractures (any site, clinical spine and non-vertebral) according to AS status and time since AS diagnosis. Multivariate models were adjusted for fracture history, socio-economic status, previous medical consultations, alcoholism and use of oral glucocorticoids. We identified 139/124,655 (0.11%) AS fracture cases, compared to 271/373,962 (0.07%) AS controls. Unadjusted (age- and gender-matched) odds ratio (OR) were 1.54 [95% confidence interval (95%CI) 1.26-1.89] for any fracture, 5.42 [2.50-11.70] for spine and 1.39 [1.12-1.73] for non-vertebral fracture. The risk peaked in the first 2.5 years following AS diagnosis: OR 2.69 [1.84-3.92] for any fracture. Patients with AS have a 5-fold higher risk of clinical spine fracture and a 35% increased risk of non-vertebral fracture. This excess risk peaks early, in the first 2.5 years of AS disease. Patients should be assessed for fracture risk early after AS diagnosis.Keywords
This publication has 34 references indexed in Scilit:
- High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic reviewClinical Rheumatology, 2012
- Cardiovascular profile in ankylosing spondylitis: A systematic review and meta‐analysisArthritis Care & Research, 2011
- Prevalence of Vertebral Fractures by Semiautomated Morphometry in Patients with Ankylosing SpondylitisThe Journal of Rheumatology, 2011
- The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysisOsteoporosis International, 2010
- Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control studyAnnals Of The Rheumatic Diseases, 2008
- Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complicationsEuropean Spine Journal, 2008
- Pulmonary involvement in ankylosing spondylitisCurrent Opinion in Pulmonary Medicine, 2006
- Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trialArthritis & Rheumatism, 2005
- Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis.Annals Of The Rheumatic Diseases, 1994
- The risk of developing ankylosing spondylitis in HLA‐B27 positive individualsArthritis & Rheumatism, 1984