Background/Purpose: Patients with inflammatory myositis have increased prevalence of symptomatic fractures. Early detection of asymptomatic vertebral fractures may help in their prevention. We studied the frequency of asymptomatic vertebral fracture and its risk factors in inflammatory myositis.

Methods: Adults with inflammatory myositis were included and dorsal and lumbar spine lateral radiographs were taken. The scoring was done using Genant’s semi-quantitative method. Besides demographic data, weight, height, postmenopausal status, duration of corticosteroid use, anticonvulsants, calcium supplements, and other co-morbidities like diabetes or hypothyroidism and past history of non-vertebral fracture were recorded. Bone mineral density was done using DEXA. Myositis Damage Index (MDI) was also assessed. All results are expressed in median and IQR.

Results: 100 patients (82 females) with myositis of age 35.5 (28.5-46) years and disease duration 3 (1.81-8.0) years were studied. Twenty patients were postmenopausal women. 35 patients had adult dermatomyositis (DM), 26 each had polymyositis and 26 connective tissue disease associated myositis and 13 had juvenile onset myositis. Forty-six patients had asymptomatic vertebral fractures. 19 patients had more than one fracture. Half the fractures occurred in those with disease <5 years. Of the 69 fractures, 47 (68.1%) were mild, 16 (23.2%) were moderate and 6 (8.7%) were severe. 11^th and 12^th thoracic vertebrae were most commonly affected. Of the 67 patients who underwent BMD assessment, 62.7% were osteopenic and 26.9% were osteoporotic. T scores of DEXA scan at the lower third of the radius correlated negatively with fracture number (r=-0.27 (-0.50 to -0.005), p=0.04). Gender, age, duration of disease, intake of corticosteroid or calcium, BMI, menopausal status, or MDI had no correlation with number of fractures.  

Conclusion: Patients with inflammatory myositis have high prevalance of asymptomatic vertebral fractures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-asymptomatic-vertebral-fractures-in-inflammatory-myositis/