PO:33:200 | Analysis of risk factors associated with vertebral fractures in systemic sclerosis: evidence from the "Sclero-RER" study group

Alessandra Bezzi¹, Federica Lumetti², Martina Orlandi³, Fabio Mascella¹, Maria Cristina Focherini¹, Eugenio Arrigoni⁴, Elena Bravi⁴, Andrea Lo Monaco⁵, Amelia Spinella³, Ottavio Secchi³, Gianluigi Bajocchi⁶, Francesco Girelli⁷, Francesco Ursini⁸, Pierluigi Cataleta⁹, Massimo Reta¹⁰, Alarico Ariani^11|12, Dilia Giuggioli³ | ¹Internal Medicine and Rheumatology Unit, AUSL Romagna, Rimini ²AUSL of Modena and Rheumatology Unit, University Hospital Policlinico of Modena; ³Rheumatology Unit, University of Modena and Reggio Emilia; ⁴Rheumatology Unit, Guglielmo da Saliceto Hospital, Piacenza; ⁵Rheumatology, department of medical sciences, University of Ferrara; ⁶Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova Reggio Emilia; ⁷Rheumatology Unit, G.B. Morgagni - L. Pierantoni Hospital, Forlì; ⁸Rizzoli Orthopedic Institute, Rheumatology Unit, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum Bologna; ⁹Hospital Santa Maria delle Croci, Rheumatology Unit, Department of Internal medicine, AUSL-Romagna Ravenna; ¹⁰Rheumatology Unit, AUSL of Bologna, Sant'Orsola Polyclinic Hospital, AOU IRCCS of Bologna; ¹¹Internal Medicine and Rheumatology Unit, University Hospital of Parma; ¹²AUSL Bologna and University of Bologna, IRCCS Policlinico Sant'Orsola, Bologna, Italy

Background. Systemic sclerosis (SSc) is a rare disease characterised by fibrosis of the skin and internal organs, as well as vascular involvement. Recent evidence indicates that osteoporosis (OP) is a frequent comorbidity in patients with SSc, with an estimated prevalence of 27%. However, specific risk factors for vertebral fractures in these patients remain unclear. This study aims to identify both general risk factors (age, BMI, age at menopause, family history of fragility fractures, smoking, steroid therapy, and femoral and vertebral T-score) and SSc-related factors (disease duration, autoimmune profile, visceral involvement) associated with the presence of vertebral fractures in patients with SSc and suspected osteoporosis.

Materials and Methods. A cross-sectional multicenter study conducted by the "Sclero-RER" group in Emilia-Romagna. Consecutive patients diagnosed with SSc (2013 ACR/EULAR criteria) were included, assessed with bone densitometry (DXA) and vertebral imaging. Collected data included: demographic parameters, disease duration, autoantibody profile, osteometabolic tests, organ involvement, and therapies. Statistical analysis used a stepwise logistic regression model to evaluate the association between risk factors and vertebral fractures (significance: p ≤ 0.05).

Results. 103 patients were enrolled (97.1% women, all postmenopausal). Osteoporosis was present in 52.4%, 38.8% had at least one vertebral fracture, and 28.1% had osteopenia. In the model with general factors, a family history of major fragility fractures and the vertebral T-score were significant predictors. When integrating SSc-specific factors, only family history and gastrointestinal (GI) involvement remained associated with the occurrence of vertebral fractures (OR 13.8 p=0.03 and OR 1.6 p=0.05, respectively). Pulmonary involvement and diffuse cutaneous SSc (DcSSc) showed a non-significant trend.

Conclusions. This study highlights that both general risk factors (family history of fragility fractures) and specific factors (GI involvement) in patients with SSc are associated with the presence of vertebral fractures. GI involvement, in particular, could negatively affect nutrient absorption, increasing the risk of fractures. These results support the use of targeted preventive strategies in patients with SSc and GI involvement, in order to reduce the risk of vertebral fractures. However, further studies will be necessary to confirm these associations.