Bone density, ultrasound measurements and body composition in early ankylosing spondylitis (original) (raw)
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The Egyptian Rheumatologist, 2015
Aim of the work: The aim of this work was to assess the bone mineral density (BMD) in Ankylosing Spondylitis (AS) patients and to investigate its relation with clinical and laboratory parameters, imaging of sacroiliac joints, disease activity and physical function. Patients and methods: 44 patients were recruited from the Rheumatology outpatient clinic of the Kasr El-Aini Hospital, their mean age was 33 ± 8.7 years. Twenty age and sex matched subjects were included as controls. Dual energy X-ray absorptiometry (DEXA) was performed for the patients and control. Disease activity and physical function were assessed using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI), respectively. Results: The T-scores of the spine, hip and forearm were lower in patients compared to controls. Low BMD was more found among patients with chronic sacroiliitis. There were significant negative correlations between chin to chest and occiput to wall distance and BMD at the hip and forearm (both p < 0.05). The BMD at the spine showed a significant correlation with the BASDAI (p = 0.008) and BASFI (p = 0.03). There was no correlation between BMD at any site and patients' age, disease duration, inflammatory back pain duration, modified Scho¨ber's test, fingerto-floor test and laboratory parameters. Conclusion: The BMD was remarkably decreased at all measurement sites in AS patients. The BMD at the spine significantly negatively correlated with the disease activity and physical function. Bone loss in AS can be explained partly by the role of inflammatory mediators and partly as a consequence of reduced physical activity.
Bone Mineral Density in Patients with Ankylosing Spondylitis
Archives of Rheumatology, 2008
Objective: Patients with inflammatory arthritis are at risk for osteoporosis and bone fractures. Inflammation and immobility contribute to bone loss in patients with ankylosing spondylitis (AS). The aim of this study was to determine bone mineral density (BMD) in patients with AS, and to compare the data of the AS patients with matched healthy controls. In addition, we sought to determine whether BMD values are related to disease activity in patients with AS or not. Patients and Methods: BMD measurements were performed with the use of Dual-Energy X-Ray Absorptiometry (DXA) in 62 AS patients and 36 healthy controls. BMD was measured in spine L2-4 (anterior-posterior view) and femoral neck by DXA. Results: The study showed that patients with AS have lower BMD values and t scores than healthy controls (p<0.001). Furthermore, total lomber BMD value negatively correlated with the length of disease duration in patients with AS (r=-0.322, p =0.01). Conclusion: We thought that evaluation...
Study of Bone Mineral Density in Patients with Ankylosing Spondylitis
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2013
Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spine and sacroiliac joint involvement that mainly affects young male subjects. Bone Mineral Density (BMD) loss occurs in AS disease course. Bone loss in AS appears to be multifactorial and perhaps involves different mechanisms at different stages of disease. The disease typically affects young males and is associated with progressive functional impairment, increased work disability and decreased quality of life. Osteoporosis is frequent in AS and there is a close association of bone mineral density, bone metabolism and inflammatory activity. Osteoporosis is frequently associated with AS and BMD decreased predominantly in patients with active disease. Aims & Objectives: The aim of the present study was to study bone mineral density in cases of Ankylosing Spondylitis (AS) in comparison to age and sex matched controls. Material and Methods: The present study was conducted on 100 established cases of AS based on modified New York criteria and 150 controls healthy, age, race, socioeconomic matched controls patients. The results were statistically analyzed. Results: Hundred cases of AS were subjected to undergo BMD by Dual Energy X-ray Absorption (DEXA) scan of different age groups in cases 35.19± 8.23(min age 23-max age 67years) and controls 33.27±5.22(min age 22years-max age 44years) with height observed in cases is 169.67±6-87 and controls 170.99±7.16 with weight varied in cases 65.63±10.27 and controls 70.14±10.67. Conclusion: Osteoporosis is a significant complication in ankylosing spondylitis and needs to be monitored and managed at the earliest. Significant osteoporosis can occur even in early disease. Osteoporosis of spine is much more prevalent than femur.BMD spine is still the most important site to define osteoporosis in ankylosing spondylitis. Rise in BMD in LS spine with duration, is not exclusive for subjects with radiologically evident syndesmophytes. Statistically, presence of syndesmophytes did not affect estimation of osteoporosis of spine.
Rheumatology International, 2012
In ankylosing spondylitis, inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis. In 80 patients with established ankylosing spondylitis, disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analog scale. BMD was measured by dual-energy X-ray absorptiometry. There was a significant negative correlation of bone density T scores with acute-phase reactants (i.e., patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine. There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly, more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (P = 0.030).
Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment
Arthritis Research & Therapy, 2012
Introduction: Osteoporosis can be a complication of ankylosing spondylitis (AS), but diagnosing spinal osteoporosis can be difficult since pathologic new bone formation interferes with the assessment of the bone mineral density (BMD). The aims of the current study were to investigate prevalence and risk factors for reduced BMD in a Swedish cohort of AS patients, and to examine how progressive ankylosis influences BMD with the use of dual-energy x-ray absorptiometry (DXA) of the lumbar spine in different projections. Methods: Methods of assessment were questionnaires, back mobility tests, blood samples, lateral spine radiographs for syndesmophyte grading (mSASSS), DXA of the hip, radius and lumbar spine in anteroposterior (AP) and lateral projections with estimation of volumetric BMD (vBMD).
Rheumatology International, 2012
Background Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis (AS). The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS. Methods Fifty-nine AS patients and 40 healthy controls were enrolled. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DEXA) at posterior-anterior (PA) lumbar, lateral lumbar and hip regions. Thoracic and lumbar X-rays were obtained for morphometric measurements. Clinical, biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiology Index-total (BASRI-t), erythrocyte sedimentation rate (ESR) and the C-reactive protein levels.
Changes in Bone Density in Patients with Ankylosing Spondylitis: A Two-Year Follow-Up Study
Osteoporosis International, 2001
The objectives of the study were to determine the 2 year rate of bone changes in patients with ankylosing spondylitis (AS) and, whether bone loss is related to physical impairment, systemic inflammation, and therapy. Consecutive outpatients fulfilling the modified New York criteria for AS were included. Baseline assessment included age, disease duration, treatment, clinical, radiologic and laboratory data. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were determined every 6 months. Persistent systemic inflammation was defined as mean ESR 5 28 mm/h or mean CRP 5 15 mg/l. Bone mineral density (BMD) at the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, at baseline and year 2. Statistical analysis compared the baseline and 24 month follow-up BMD data, and determined whether baseline data, and persistent systemic inflammation during the 2 years, were related to the 24 month percentage changes in BMD. Fifty-four patients (35 men, 19 women; mean age 37.3 Ô 11.3 years, mean disease duration 12.4 Ô 8.6 years) were included. After 2 years, BMD did not change at the lumbar spine (+0.75% Ô 3.5, p = 0.23), and decreased at the femoral neck (-1.6% Ô 4, p = 0.006). The 24 month percentage change in femoral neck BMD was related to persistent systemic inflammation, defined using ESR (mean percentage change -4.1% Ô 5.7 and -1.2% Ô 3.9 in patients with and without persistent inflammation; respectively; p = 0.007). These results suggest that persistent inflammation might be an etiologic factor of bone loss in AS.
2014
Introduction: Ankylosing spondylitis (AS) is characterized by excessive bone formation and bone loss. Our aim was to investigate the association of bone turnover markers (BTM) with spinal radiographic damage and bone mineral density (BMD) in AS patients with active disease. Methods: 201 consecutive AS outpatients of the Groningen Leeuwarden AS (GLAS) cohort were included. Serum markers of bone resorption (C-telopeptides of type-I collagen, sCTX) and bone formation (procollagen type-I N-terminal peptide, PINP; bone-specific alkaline phosphatase, BALP) were measured. Z-scores were used to correct for the normal influence that age and gender have on bone turnover. Radiographs were scored by two independent readers according to modified Stoke AS Spinal Score (mSASSS). The presence of complete bridging (ankylosis of at least two vertebrae) was considered as measure of more advanced radiographic damage. Low BMD was defined as lumbar spine and/or hip BMD Z-score # 21. Results: Of the 151 patients with complete data, 52 (34%) had 1completebridge,49(331 complete bridge, 49 (33%) had 1completebridge,49(331 syndesmophyte (nonbridging), and 50 (33%) had no syndesmophytes. 66 (44%) had low BMD. Patients with bridging had significantly higher sCTX and PINP Z-scores than patients without bridging (0.43 vs. 20.55 and 0.55 vs. 0.04, respectively). Patients with low BMD had significantly higher sCTX Z-score than patients with normal BMD (20.08 vs. 20.61). After correcting for gender, symptom duration, and CRP, sCTX Z-score remained significantly related to the presence of low BMD alone (OR: 1.60), bridging alone (OR: 1.82), and bridging in combination with low BMD (OR: 2.26). Conclusions: This cross-sectional study in AS patients with active and relatively long-standing disease demonstrated that higher serum levels of sCTX, and to a lesser extent PINP, are associated with the presence of complete bridging. sCTX was also associated with low BMD. Longitudinal studies are needed to confirm that serum levels of sCTX can serve as objective marker for bone-related outcome in AS.
Is Osteoporosis Generalized or Localized to Central Skeleton in Ankylosing Spondylitis
Jcr-journal of Clinical Rheumatology, 2007
Background: Osteoporosis at the lumbar spine and at the femur is a well-established complication in ankylosing spondylitis (AS), but the exact mechanism and the distribution of osteoporosis are not known absolutely. Objective: To determine whether the osteoporosis is generalized or localized to central skeleton and to examine the relation between bone mineral density (BMD) and disease activity and radiologic progression in patients with AS. Methods: In this study, 26 patients with AS and 33 healthy controls matched for age and sex were recruited to the study. Hip and forearm BMD were measured by dual energy X-ray absorptiometry (DEXA). Laboratory and clinical disease activity parameters were documented, and anteroposterior sacroiliac radiographs were taken to determine the radiologic progression. Results: The urine deoxypyridinoline levels of the patients with AS were statistically significantly higher (P ϭ 0.02) and the serum osteocalcin levels were significantly lower with respect to controls (P ϭ 0.03). The femoral neck and femur BMD values and T scores were significantly lower in patients with AS compared with the controls (P ϭ 0.019, 0.003, 0.01, and 0.01, respectively). The differences in BMD values and T scores of the distal 1/3 radius between 2 groups were not statistically significant. The relation between BMD and disease activity, and radiologic progression in patients with AS could not detected. Conclusion: Sparing of distal regions such as the as radius suggests that osteoporosis might be due to localized effects of inflammatory activity or immobility rather than a systemic effect. Both increased resorption and decreased formation might be involved in the pathogenesis of osteoporosis. Radius BMD may not be appropriate to evaluate bone loss in patients with AS.