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

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. People with idiopathic inflammatory myopathies, a group of diseases that cause muscle inflammation and weakness, often experience significant challenges that can affect their daily activities and make them more prone to falls and injuries. A survey conducted by Myositis Support and Understanding asked its members with idiopathic inflammatory myopathies about their experience with falls, bone fractures, and treatments for their condition. The results showed that 79.8% of the 470 survey respondents had fallen at least once since their diagnosis and 57.0% had fallen in the past year. Among the 25.7% of people who experienced fall-related fractures, half of them had multiple fractures, and nearly one-third needed surgery. Nearly half of the people who had fractures from falls said they were not taking any vitamins, supplements, or medications—like calcium, vitamin D, or bone-strengthening drugs—to help protect their bones or prevent more fractures. To help with mobility, 18.2% of people used braces or splints, and 77.7% used mobility aids such as walkers or canes. People with inclusion body myositis and people with polymyositis had a higher risk of falling compared with those with dermatomyositis. Although all types of idiopathic inflammatory myopathies can cause serious muscle weakness, some may increase the risk of falls more than others. Preventing falls and fractures is critical for improving the quality of life of people with idiopathic inflammatory myopathies.