Exploring Disease-Specific Risk Factors for Vertebral Fractures in Systemic Sclerosis: Insights from the ScleroRER Study Group

Background/Objectives: Systemic sclerosis (SSc) patients frequently develop osteoporosis;
however, vertebral fracture risk factors remain poorly characterized. This study identi-
fies general and SSc-specific predictors of vertebral fractures in SSc patients undergoing
osteoporosis evaluation. Methods: This multicenter cross-sectional study enrolled con-
secutive SSc patients meeting ACR/EULAR 2013 criteria with suspected osteoporosis.
Data included demographics, disease characteristics, bone density (DXA), and vertebral
imaging. Stepwise logistic regression analyzed fracture associations (p ≤ 0.05 significant).
Results: The majority of 103 enrolled patients were female and all were post-menopausal.
The prevalence of osteoporosis was 52.4%, that of vertebral fractures was 38.8%, and
that of osteopenia was 28.1%. General risk factor analysis identified family history of
fragility fractures (OR 11.8, p = 0.008) and vertebral T-scores (OR 0.6, p = 0.049) as
significant predictors. When adding SSc-specific factors, only family history (OR 13.8,
p = 0.03) and gastrointestinal (GI) involvement (OR 4.8, p = 0.05) remained significant.
Conclusions: Vertebral fractures in SSc patients are strongly linked to a family history of
fractures. The suggestive association with GI involvement may imply a significant role for
malabsorption-related metabolic impairment. Prioritizing bone density screening in SSc
patients with GI symptoms may enable earlier intervention and reduce fracture risk.