High prevalence of foot insufficiency fractures in patients with inflammatory rheumatic musculoskeletal diseases

To assess the prevalence of foot IF in RMD patients with foot pain.In a retrospective design, 1,752 MRIs of consecutive patients presenting with foot pain in two time periods between 2016 - 2018 were evaluated. The group with IF was matched with controls with foot pain without IF. Bone mineral density (BMD) was assessed by DXA. Multivariate analyses were performed.A total of 1,145 MRIs of patients (mean age 59 years, 83% female) with inflammatory (65.4%) or non-inflammatory RMD (34.6%) was available. Most patients had RA (42.6%), psoriatic arthritis (22.4%), axial spondyloarthritis (11.1%) or connective tissue disease (7.6%). Foot IF were found in 129 MRI of patients (7.5%). There was no difference between time periods. The prevalence of IF was highest in CTD (23%) and RA (11.4%). More patients with an inflammatory than a noninflammatory RMD had IF: 9.1% vs 4.1%, respectively (p<0.001). Using CR, IF were only detected in 25%. Low BMD and a history of fractures were more frequent in patients with IF: 42.6% vs 16.2% and 34.9% vs 8.6%, respectively (p<0.001).A high prevalence of foot fractures was found in MRI of RMD patients, many without osteoporosis. MRI was more sensitive than X-rays to detect IF.