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Development of Spinal Enthesopathies in Adults With X-linked Hypophosphatemia
Julia Herrou1,2, Jacques Fechtenbaum2, Anya Rothenbuhler3,4,5
1Department of Rheumatology, INSERM UMR 1153, Université de Paris-Cité, APHP Centre, Cochin Hospital, 75014 Paris, France.
Context:
Musculoskeletal complications are the main manifestations in adults with X-linked hypophosphatemia (XLH). Enthesopathy significantly impairs quality of life.
Objective:
To identify the risk factors associated with the development and progression of spinal enthesopathies in adults with XLH.
Design And Setting:
We conducted a retrospective study in the French Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism.
Patients:
Adults XLH patients with 2 EOS® imaging performed at least 2 years apart at the same center between June 2011 and March 2022. The progression of enthesopathies was defined as a new enthesopathy at least 1 intervertebral level in patients with or without presence of enthesopathy at baseline.
Main Outcome Measures:
Demographic, treatment, PHEX mutation with the progression of enthesopathies.
Results:
Fifty-one patients (66.7% of women, mean age 42.1 ± 13.4 years) underwent 2 EOS imaging with an average interval of 5.7 (± 2.31) years.Progression of spinal enthesopathies was observed in 27 (52.9%) patients. In univariate analysis, patients with a progression of spinal enthesopathies were significantly older (P < .0005), were significantly older at treatment initiation (P = .02), presented with dental complications (P = .03), received less frequently treatment during childhood with phosphate and/or vitamin D analogs (P = .06), and presented more frequently with hip osteoarthritis (P = .002) at baseline. In multivariate analysis, none of these factors was associated with a progression of spinal enthesopathies.
Conclusion:
This study confirms the high proportion of patients with a progression of spinal enthesopathies. Age seems to be the main factor associated with progression.
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