Clinical Vertebral Fractures in Patients with Ankylosing Spondylitis

DEBBY VOSSE, ERNST FELDTKELLER, JON ERLENDSSON, PIET GEUSENS, and SJEF van der LINDEN

ABSTRACT.

Objective. To evaluate the prevalence and characteristics of clinically confirmed vertebral fractures (CVF) in patients with ankylosing spondylitis (AS).

Methods. Coordinated by the Ankylosing Spondylitis International Federation in Germany and in Denmark, a self-administered questionnaire was sent to all their members about age, diagnosis, disease duration, HLA-B27 status, and history of CVF. Patients who were aware of having had a CVF were asked to return the questionnaire with additional specification of the location of CVF, associated trauma, neurological complications, therapy for these complications, and recovery. We also reviewed available radiographs.

Results. Out of 15,097 questionnaires, 59 patients (0.4%) reporting 66 CVF returned the complete questionnaire (46 men, 13 women). Mean age at fracture was 50 ± 9 years, after a mean duration of symptoms of 26 ± 11 years. CVF with wedging or crush or transverse fracture were reported in the cervical (n = 21, 36%), thoracic (n = 21, 36%), and lumbar spine (n = 16, 27%), with one unspecified. In 37 fractures (56%), patients reported no/low or medium trauma in relation to the fracture. In 31 fractures (47%), patients reported neurological complications, occurring mostly without trauma (n = 11, 35%) or after minimal trauma (n = 7, 23%). Twenty (65%) of these patients did not have full neurological recovery.

Conclusion. We found that 0.4% of patients with AS reported CVF at a mean age of 50 years, occurring after 2 decades of disease, mainly without trauma or after minimal trauma, with frequent neurological complications mostly followed by incomplete neurological recovery. (J Rheumatol 2004;31:1981-5)

Key Indexing Terms:

ANKYLOSING SPONDYLITIS
OSTEOPOROSIS
CLINICAL VERTEBRAL FRACTURES
NEUROLOGICAL COMPLICATIONS

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From the Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands; Department of Rheumatology, Limburg University Center, Diepenbeek, Belgium; and Department of Internal Medicine, Division of Rheumatology, Horsens Sygehus, Horsens, Denmark.

D. Vosse, MD, Rheumatologist; S. van der Linden, MD, PhD, Professor in Rheumatology, University Hospital Maastricht; P. Geusens, MD, PhD, Professor in Rheumatology, University Hospital Maastricht, Limburg University Center; J. Erlendsson, MD, Rheumatologist, Horsens Sygehus; E. Feldtkeller, PhD, Vice President, Ankylosing Spondylitis International Federation, Munich, Germany.

Address reprint requests to Dr. D. Vosse, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: dvo@sint.azm.nl

Submitted December 8, 2003; revision accepted April 26, 2004.

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