Vertebral Fractures Linked to Reduced Lung Capacity in ILD Patients: Study
Italy: A new cross-sectional study published in Respiratory Research has highlighted a significant association between vertebral fractures and impaired lung function in patients with interstitial lung disease (ILD), highlighting the importance of evaluating bone health in this population.
The research, led by Angelo Fassio from the Rheumatology Unit at the University of Verona, Policlinico BG Rossi, Italy, explored whether thoracic vertebral fractures influence pulmonary function independently of ILD subtype and structural lung abnormalities. While ILDs are primarily characterized by progressive scarring of lung tissue, their systemic effects — including skeletal involvement — are gaining increasing attention.
To investigate this relationship, the researchers analyzed 200 adult patients with confirmed ILD. The cohort had a mean age of 66.4 years, and just over half (51.5%) were men. Among them, 76 patients had idiopathic pulmonary fibrosis (IPF), 65 had systemic sclerosis-associated ILD (SSc-ILD), 31 had idiopathic inflammatory myopathy-associated ILD, and 28 had other forms of ILD.
All participants underwent high-resolution computed tomography (HRCT) and comprehensive pulmonary function testing. Lung function parameters included percent predicted and absolute values of forced vital capacity (FVC) and total lung capacity (TLC), forced expiratory volume in one second (FEV₁), and percent predicted diffusing capacity of carbon monoxide (DLCO). Vertebral fractures from thoracic levels T4 to T12 were evaluated on sagittal HRCT images using the spinal deformity index (SDI), a validated radiographic scoring system that quantifies cumulative vertebral fracture burden on a scale from 0 (normal) to 3 (severe deformity). Higher SDI scores reflect more extensive vertebral damage.
The study revealed the following findings:
- A total of 23% of patients had at least one mild thoracic vertebral fracture.
- Greater vertebral fracture burden was consistently associated with reduced lung volumes across all ILD subgroups.
- Each 1-point increase in the spinal deformity index (SDI) was linked to a 2.9% decrease in percent predicted forced vital capacity (FVC) and a 2.7% decrease in percent predicted total lung capacity (TLC).
- In absolute terms, every 1-point rise in SDI corresponded to a decline of approximately 95.6 mL in FVC and 199.5 mL in TLC.
- Higher SDI scores were associated with a percent reduction predicted diffusing capacity of carbon monoxide (DLCO), although this association was not statistically significant.
- The relationship between vertebral fractures and reduced lung volumes remained significant even after adjusting for ILD pattern and thoracic morphometric indices.
The authors noted that these findings point to a previously underrecognized interaction between skeletal fragility and pulmonary function in fibrosing lung disease. They emphasized that incorporating vertebral assessment into routine ILD evaluation could enhance patient management.
Overall, the study provides new evidence that vertebral fractures are not merely incidental findings in ILD but may contribute independently to respiratory impairment, highlighting the need for a more integrated bone–lung approach in clinical practice.
Reference:
Fassio , A., Pollastri , F., Appoloni , M. et al. The impact of vertebral fractures on pulmonary function tests in patients with interstitial lung disease: a cross-sectional study. Respir Res (2026). https://doi.org/10.1186/s12931-026-03552-2
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