StandForAS video 5: 5 things every ankylosing Spondylitis warrior should know about
What Everyone With Ankylosing Spondylitis Should Know About Fractures
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If you have ankylosing spondylitis — a form of inflammatory arthritis that primarily affects the spine — you may also have a higher risk for spinal fractures, even after seemingly minor traumas.
“[With ankylosing spondylitis], new bony spurs form and cause the vertebrae to fuse together, robbing your spine of mobility and leaving it vulnerable to fractures,” says Susan Goodman, MD, a rheumatologist with the Hospital for Special Surgery in New York City.
“It’s paradoxical in a sense as the disease process is characterized by the proliferation of bone — the amount of bone is increasing, but when we look at trabecular bone, we can see it is really quite weak,” says Dr. Goodman. Trabecular bone comprises the bone’s inner layer and has a spongy structure, according to the U.S. National Library of Medicine.
In addition, up to half of all people with ankylosing spondylitis also have osteoporosis, according to the American College of Rheumatology. Osteoporosis can lead to weakened bones and increase the risk of spinal fracture.
That’s why it’s important to find ways to preserve your bone strength and lower your risk of injury. Here’s how to get started.
Are You at Risk for a Fracture?
The best way to get ahead of a potential fracture is to test your bone density, says Runsheng Wang, MD, a rheumatologist and instructor at Columbia University Medical Center in New York City. Getting a bone density (DEXA) scan is a good place to start, but “a more detailed bone analysis such as a CT scan may be needed to get a more accurate gauge of bone density," Dr. Wang says.
Older people with more advanced ankylosing spondylitis, those with low bone density in the hip, and those who lead a less healthy lifestyle are at the greatest risk for vertebral fractures, according to research published inArthritis Care and Researchin July 2019.
Because the fractures can occur even with minor trauma, you might not even realize that you sustained one, Goodman says. “People with ankylosing spondylitis are so used to pain that they may just put up with it," she says.
Besides pain, another possible sign of a fracture may be an improvement in range of motion. That can occur because the bony spurs are no longer preventing movement, Goodman explains. But, if the fractures are in your spine, she adds, your vertebrae could collapse and cause your back to bend forward even more than it already does. Some fractures can even compress nerves in the spine and result in paralysis.
How to Prevent Fractures
“The higher the disease activity, the greater the risk of fracture,” Wang says. So, treating your ankylosing spondylitis and reducing the inflammation should help improve your bone density. Talk to your rheumatologist to make sure you're doing all that you can to treat your ankylosing spondylitis and reduce fracture risk.
Optimizing bone health is also important. “Getting adequate calcium and vitamin D and engaging in regular weight-bearing exercise can all help to preserve bone strength and integrity," Goodman says.
Depending on the results of your bone scan and other risk factors, your doctor may also recommend osteoporosis medication, Wang adds.
Another rule: “Pay attention to your surroundings and be careful,” Wang says.
Video: 10 Things Everybody Should Know About Invisible Illness, Ankylosing Spondylitis | SAAHAS
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