Prediction of Vertebral Fractures by Trabecular Bone Score in Patients With Ankylosing Spondylitis

Ankylosing spondylarthritis (AS) is associated falsely increased lumbar spine bone mineral density (BMD). New tool for discrimination of subjects at fracture risk is needed. Vertebral fracture (VF) prediction of routine methods for osteoporosis assessment, BMD and trabecular bone score (TBS), in patients with AS. Cross-sectional study of all AS patients regularly followed at the rheumatology outpatient clinics of two centers. All subjects undergone BMD measurement at lumbar spine (LS), total hip (TH) and femoral neck (FN) using Hologic (R) Horizon device. TBS at L1-4 in all subjects by TBS InSight (R) software were assessed. Vertebral fracture assessment (VFA) was performed using the lateral spine imaging IVA (TM) and graded using Genant semi-quantitative approach. 119 AS subjects (90 males/29 females), mean age 47.6 years were included in the study. In 20 patients 34 VFs were detected, from whom 7 patients had multiple fractures. Subjects with VF were older and had lower FN BMD, TBS in comparison to non-VF subjects. No differences in LS BMD, FN BMD or BASDAI between groups were observed. Among patients with VF only 3 had T-score less than -2.5 but 7 has TBS less than 1.23 which means highly degraded microarchitecture. AS patients with VF have lower TBS and FN BMD in comparison to non-VF subjects. In addition, TBS was able to detect 20 % more VFs than BMD. Therefore, TBS seems promising in VF discrimination among patients with AS.

Automated summary

AS patients with vertebral fractures tend to be older and have lower values in FN BMD and TBS compared to those without vertebral fractures. TBS was able to detect 20% more vertebral fractures than BMD, indicating its promising potential in vertebral fracture discrimination among AS patients.