Fracture Risk Factors Described in Ankylosing Spondylitis

Heidi Splete

September 07, 2023


Opioid use, older age, and fracture history increase the risk for fractures in older adults with ankylosing spondylitis (AS) based on a review of registry and Medicare claims data.


  • Rheumatology Informatics System for Effectiveness (RISE) registry data were linked to Medicare claims from 2016 to 2018; each patient had two AS International Classification of Diseases–9 and –10 codes at least 30 days apart.

  • The study population included 1426 adults with AS (mean age, 69.4 years) who had continuous Medicare enrollment (Parts A and B) for the entire follow-up period but did not have Medicare Advantage Plan (Part C).

  • The researchers used a logistic regression analysis to identify factors associated with fractures including age, sex, and body mass index.


  • The overall incidence of fractures was 76.7 per 1000 person-years.

  • Older age, history of fracture, and opioid use at a morphine-equivalent dose > 30 mg (at least one prescription 30 or more days prior to the index date) were significantly associated with increased risk for fracture (odds ratios, 2.8, 5.24, and 1.86, respectively).

  • Fracture risk was equally likely for men and women.


The study supports fracture risk-reduction strategies for men and women with AS and a fracture history, with added attention to opioid users.


The first author of the study was Rachael Stovall, MD, of the University of California, San Francisco. The study was published August 22, 2023, in Arthritis Care & Research.


The study does not include individuals younger than 65 years and references only first fractures. Some EHR data on variables including race, body mass index, national area deprivation index, and smoking status are incomplete.


The study was supported by various grants from the National Center for Advancing Translational Sciences, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Rheumatology Research Foundation.

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