[Management of vertebral fractures in patients with immune-mediated inflammatory diseases]

Patients with immune-mediated inflammatory diseases (IMID) are characterized by increased vulnerability to spinal trauma and distinct fracture patterns. Inflammatory alterations of periosseous soft tissues, along with impaired bone metabolism, lead to reduced mechanical resilience with unfavorable spinal alignment and biomechanics. A common denominator across IMID is secondary osteoporosis, which predisposes patients to pathological or fragility fractures, often triggered by low-impact trauma. Due to the heterogeneity of postinflammatory changes, ranging from focal structural destruction to long-segment ankylosis, the fracture morphology within this patient group varies considerably. From both a pathomechanical and therapeutic perspective, osteoporotic fractures must be clearly distinguished from fractures occurring in ankylosing diseases. Although reduced bone density and insufficient residual stability may endanger the spinal cord in the long run, fractures of a fused spine carry an acute risk of displacement and spinal cord injury, potentially resulting in paraplegia. Despite these differences, the therapeutic goal remains the same: to achieve a mechanically stable osseous bridging of the fractured segment. This article highlights the distinct challenges of fracture management in various IMID types compared to structurally healthy spines. This is illustrated based on two representative clinical cases.