Background/Purpose: Systemic sclerosis (SS) is a rare connective tissue disorder characterized by progressive fibrosis of the skin and internal organs, including lungs, heart and kidneys. Furthermore, SS may increase osteoporosis risk due to chronic inflammatory state, malabsorption/malnutrition, limited mobility and use of corticosteroids therapy. Currently, emerging evidences suggest that SS might represent an independent factor for low BMD, further compromising skeletal health. Additionally, SS patients generally present with overlapping comorbidities, such as rheumatoid arthritis, hypercholesterolemia, hypothyroidism, etc., which may further exacerbate fracture risk (FR) and overall health outcomes. Given the fragile health status of this population, early identification of skeletal fragility is essential for optimal patient management and improved quality life. For this, the present study aims to assess the impact of SS on imminent (within 5 y) FR using Radiofrequency Echographic Multi Spectrometry (REMS) technology, by comparing patients either with SS alone and with SS plus additional comorbidities. A secondary aim is to explore the contribution of comorbidities to increased FR.

Methods: The 5-y FR analysis was assessed by combining both quantitative (BMD, T- and Z-score) and qualitative (bone microarchitecture via Fragility Score, FS) data. REMS technology automatically provides a risk classification system consisting of 7 increasing risk levels, named from R1 to R7, each corresponding to a defined probability of imminent FR. To ascertain the impact of comorbidities on the likelihood of experiencing an incident fracture, a logistic regression was performed.

Results: A cohort of 91 Caucasian patients (both genders) either affected by SS (n = 64, median age: 64.3 yo, 42.2% women < 65 yo) or by SS + other comorbidities (n = 27, median age: 69 yo, and 33.3% women < 65 yo) underwent spinal REMS scan. The FR analysis at major osteoporotic fracture showed that SS patients were classified as follows: R1 (9.3%), R3 (42.2%), R4 (1.6%), R5 (20.3%), R6 (6.3%) and R7 (20.3%). Likewise, SS + comorbidities showed a similar distribution across the 7 classes: 3.7% (R1), 48.2% (R3), 7.4% (R4), 18.5% (R5), 3.7% (R6) and 18.5% (R7). Likewise, the T-score and FS analyses showed similar values between the SS (T-score: -2.2 ± 0.8 and FS: 41.4 ± 19.9; mean ± SD) and SS + comorbidities (T-score: -2.3 ± 0.7 and FS: 43.8 ± 20.4; mean ± SD). Logistic regression did not show any significant association between SS or SS + comorbidities and increased FR, thus indicating that the overlap of other pathological conditions does not exacerbate an already altered skeletal health status.

Conclusion: In conclusion, in our study SS alone appeared to be the primary factor contributing to compromised bone quality and quantity. These findings underscore the importance of early bone health assessment and monitoring in SS patients through REMS technology, particularly given the potential for skeletal fragility even in the absence of additional comorbidities. Clinical studies focusing also on exploring the impact of a single comorbidity rather than grouped multiple factors are ongoing to assess how each comorbidity influences fracture skeletal risk in SS patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rems-technology-5-y-imminent-fracture-risk-in-systemic-sclerosis/