High Prevalence of Foot Insufficiency Fractures in Patients With Inflammatory Rheumatic Musculoskeletal Diseases

Bjoern Buehring; Nadine Al-Azem; Uta Kiltz; Martin Fruth; Ioana Andreica; David Kiefer; Styliani Tsiami; Xenofon Baraliakos; Jürgen Braun

doi:10.3899/jrheum.220758

High Prevalence of Foot Insufficiency Fractures in Patients With Inflammatory Rheumatic Musculoskeletal Diseases

J Rheumatol. 2023 Aug;50(8):1071-1077. doi: 10.3899/jrheum.220758. Epub 2022 Dec 15.

Authors

Bjoern Buehring¹, Nadine Al-Azem¹, Uta Kiltz¹, Martin Fruth², Ioana Andreica¹, David Kiefer¹, Styliani Tsiami¹, Xenofon Baraliakos¹, Jürgen Braun³

Affiliations

¹ B. Buehring, MD, N. Al-Azem, MD, U. Kiltz, MD, I. Andreica, MD, D. Kiefer, MD, S. Tsiami, MD, X. Baraliakos, MD, J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne, and Ruhr-Universität Bochum, Bochum.
² M. Fruth, MD, Radiologie Herne, Herne, Germany.
³ B. Buehring, MD, N. Al-Azem, MD, U. Kiltz, MD, I. Andreica, MD, D. Kiefer, MD, S. Tsiami, MD, X. Baraliakos, MD, J. Braun, MD, Rheumazentrum Ruhrgebiet, Herne, and Ruhr-Universität Bochum, Bochum; juebraun@gmx.de.

PMID: 36521920
DOI: 10.3899/jrheum.220758

Abstract

Objective: To assess the prevalence of foot insufficiency fractures (IF) in patients with rheumatic musculoskeletal disease (RMD) with foot pain.

Methods: In a retrospective design, 1752 magnetic resonance imaging (MRI) scans of consecutive patients presenting with foot pain in 2 time periods between 2016 and 2018 were evaluated. The group with IF was matched with controls with foot pain without IF. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Multivariate analyses were performed.

Results: A total of 1145 MRI scans of patients (median age 59 yrs, 82.9% female) with an inflammatory (65.4%) and of 607 with no inflammatory (34.6%) RMD (median age 58 yrs, 80.8% female) were available. Most patients had rheumatoid arthritis (RA; 42.2%), and others had psoriatic arthritis (22.4%), axial spondyloarthritis (11.1%), or connective tissue disease (CTD; 7.6%). Foot IF were found in 129 MRI scans of patients (7.5%). There was no difference between time periods. The prevalence of IF was highest in CTD (23%) and RA (11.4%). More patients with an inflammatory than a noninflammatory RMD had IF (9.1% vs 4.1%, respectively; P < 0.001). Using conventional radiography, IF were only detected in 25%. Low BMD and a history of fractures were more frequent in patients with IF than without (42.6% vs 16.2% and 34.9% vs 8.6%, respectively; P < 0.001).

Conclusion: A high prevalence of foot fractures was found in MRI scans of patients with RMD, many without osteoporosis. MRI was more sensitive than radiographs to detect IF.

Keywords: bone mineral density; fragility fractures; osteoporosis; rheumatoid arthritis.

MeSH terms

Absorptiometry, Photon / methods
Bone Density
Female
Foot Diseases*
Fractures, Stress* / diagnostic imaging
Fractures, Stress* / epidemiology
Humans
Male
Middle Aged
Musculoskeletal Diseases*
Pain
Prevalence
Retrospective Studies