Prevalence and Risk of Falls and Fractures in the Idiopathic Inflammatory Myopathies: A Cross-Sectional Study of 470...

Patients with idiopathic inflammatory myopathies (IIMs) can develop marked muscle weakness, which predisposes them to falls and injuries. We examined the prevalence of falls and associated fractures, assistive device use, and bone-protective therapy use among those reporting a fracture history. This analysis focuses on secondary prevention strategies in a high-risk population.

A cross-sectional survey was developed and distributed by Myositis Support and Understanding, a patient-led advocacy organization, to members of its group. Patients aged ≥ 18 years with a diagnosis of an IIM (dermatomyositis, antisynthetase syndrome, polymyositis, inclusion body myositis [IBM], immune-mediated necrotizing myopathy, or overlap myositis [OM]) were eligible to participate. Ordinal logistic regression was utilized to identify variables independently associated with falls.

Of 470 respondents, 79.8% reported falling once since diagnosis, and 57.0% fell within the past year. Fall-related fractures since diagnosis were reported by 121 participants (25.7%), of whom 61 (50.4%) experienced ≥ 2 fractures and 39 (32.2%) required surgical treatment. Among those with fall-related fractures, nearly half (47.9%) reported not receiving any dietary supplements or pharmacologic therapies (e.g., calcium, vitamin D, or bisphosphonates) to reduce bone loss or prevent future fractures. Use of braces/splints or mobility aids was reported by 18.2% and 77.7% of participants with fall-related fractures, respectively. Regression analyses identified mobility aid usage as being associated with a significantly increased fall risk (odds ratio [OR], 3.1; P < 0.001). Relative to dermatomyositis, fall risk was significantly higher among participants with IBM (OR, 2.5; P = 0.002) and polymyositis (OR, 2.0; P = 0.037) and lower for participants with antisynthetase syndrome (OR, 0.5; P = 0.038).

All IIMs can lead to marked weakness, with varying individual risks of falls. Multidisciplinary care, with an emphasis on primary and secondary prevention of falls and fractures, is critical to improving outcomes and preserving quality of life in these patient populations.