Prognostic value of trabecular bone score for major osteoporotic fractures in patients with radiographic axial spondyloarthritis: a 3-year prospective cohort study.

BACKGROUND

Patients with radiographic axial spondyloarthritis (r-axSpA) are at an increased risk of osteoporotic fractures compared to the general population.

AIM: To evaluate the clinical utility of trabecular bone score (TBS) compared with bone mineral density (BMD) for predicting major osteoporotic fractures (MOF) in patients with radiographic axial spondyloarthritis (r-axSpA).

METHODS

A total of 63 patients with r-axSpA were included. At baseline, lumbar spine DXA, thoracic and lumbar spine X-rays, and basic demographic data were collected. Patients were followed for 3 years, after which new major osteoporotic fractures (MOF) and follow-up spine X-rays were recorded.

RESULTS

During the observation period, 7 patients experienced MOF. Of these, 6 had been classified at high risk based on TBS (TBS ≤ 1.31). On the other hand, only 1 was identified as osteopenic and none as osteoporotic based on BMD T-scores. Strongest relative risk (RR) factors for MOF included a prior MOF (RR = 13.3; p < 0.001) and presence of syndesmophytes/ankylosis (RR = 2.0; p = 0.020). Low TBS (≤ 1.31) was associated with a RR of 4.5 (hence being only a trend due to low numbers). BMD T-score < - 1.0 seemed to be not helpful in this cohort (RR = 0.64).

CONCLUSION

TBS may provide greater clinical value than BMD in identifying r-axSpA patients at increased risk of MOF. Despite limited sample size, these findings highlight the potential of TBS as a complementary diagnostic tool in routine practice.