← Questions/LIVING WITH AS
Why is everyone so worried about me falling?
The short answer
A spine that has fused behaves like a long bone: a simple fall that would bruise someone else can fracture it, and the fracture is often unstable. Trauma-centre data show people with AS need bigger operations and have higher in-hospital mortality after such injuries. The longer-term picture is better than most expect: four years on, most survivors of AS neck fractures live independently with mild pain, and half of those with spinal cord injury recovered fully.
3 papers behind this answer, best first
Clicking through to a study? How to read a paper is the ten-minute version.
Thoracolumbar Spine Trauma Outcomes: Effect of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis.
The Journal of the American Academy of Orthopaedic Surgeons
Among 189 people with thoracolumbar spine injuries, those with ankylosing spondylitis or DISH were older, were injured more often by simple falls, needed bigger operations with more levels fused, and were more likely to die in hospital or go to long-term care, though nerve recovery was similar. A stiff spine turns a minor fall into a major injury, which is the practical reason fall prevention matters so much in AS.
Long-term functional and radiological outcomes among survivors of ankylosing spondylitis-associated cervical spine fractures: a cross-sectional follow-up study.
North American Spine Society journal
Among 97 survivors of neck fractures linked to ankylosing spondylitis, followed for a median of four years, most lived independently with mild neck pain and low disability, 96 percent of fractures had healed solidly, and half of those with spinal cord injury recovered fully. These fractures are dangerous at the time, but for those who come through them the long-term picture is better than most people would expect.
Disease-modifying anti-rheumatic drugs and systemic glucocorticoid use and risk of vertebral fractures in axial spondyloarthropathies: a systematic review and meta-analysis.
Clinical rheumatology
Across ten studies, biologic and conventional disease-modifying drugs neither raised nor lowered the risk of spinal fractures in axial spondyloarthritis, and TNF and IL-17 drugs were no different from each other, but steroid tablets raised fracture risk by about 38 percent. Controlling inflammation does not by itself protect the spine from breaking, so bone health needs its own attention, and steroids are best kept to a minimum.
Plain-language guides on this from patient organisations
Reviewed sources written for patients. They cover the “what do I do” part that research papers can’t.
- NHS: Complications of AS ↗
NHS (UK)