Exploring Disease-Specific Risk Factors for Vertebral Fractures in Systemic Sclerosis: Insights from the ScleroRER Study Group

<b>Background/Objectives</b>: Systemic sclerosis (SSc) patients frequently develop osteoporosis; however, vertebral fracture risk factors remain poorly characterized. This study identifies general and SSc-specific predictors of vertebral fractures in SSc patients undergoing osteoporosis evaluation. <b>Methods:</b> This multicenter cross-sectional study enrolled consecutive SSc patients meeting ACR/EULAR 2013 criteria with suspected osteoporosis. Data included demographics, disease characteristics, bone density (DXA), and vertebral imaging. Stepwise logistic regression analyzed fracture associations (<i>p</i> ≤ 0.05 significant). <b>Results</b>: The majority of 103 enrolled patients were female and all were post-menopausal. The prevalence of osteoporosis was 52.4%, that of vertebral fractures was 38.8%, and that of osteopenia was 28.1%. General risk factor analysis identified family history of fragility fractures (OR 11.8, <i>p</i> = 0.008) and vertebral T-scores (OR 0.6, <i>p</i> = 0.049) as significant predictors. When adding SSc-specific factors, only family history (OR 13.8, <i>p</i> = 0.03) and gastrointestinal (GI) involvement (OR 4.8, <i>p</i> = 0.05) remained significant. <b>Conclusions:</b> Vertebral fractures in SSc patients are strongly linked to a family history of fractures. The suggestive association with GI involvement may imply a significant role for malabsorption-related metabolic impairment. Prioritizing bone density screening in SSc patients with GI symptoms may enable earlier intervention and reduce fracture risk.