Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study (original) (raw)
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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.
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.
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.
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...
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).
The Journal of Rheumatology, 2012
Objective.To study the prevalence and risk factors for vertebral fractures (VF) in ankylosing spondylitis (AS) and the relation between VF, measures of disease activity, and bone mineral density (BMD) in different measurement sites.Methods.Patients with AS (modified New York criteria) underwent examination, answered questionnaires, and gave blood samples. Lateral spine radiographs were scored for VF (Genant score) and syndesmophyte formation through modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). BMD was measured with dual-energy x-ray absorptiometry in the hip, radius, and lumbar spine in anteroposterior and lateral projections with estimation of volumetric BMD (vBMD).Results.Two hundred four patients (57% men) with a mean age of 50 ± 13 years and disease duration 15 ± 11 years were included. VF were diagnosed in 24 patients (12%), but were previously noted clinically in only 3 of the 24. Patients with VF were significantly older (p = 0.004), had longer disease duration...
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.
Clinical Rheumatology, 2011
The purpose of this study is to evaluate bone mineral density (BMD) and bone turnover markers in men with ankylosing spondylitis (AS) and to determine their relationship with clinical features and disease activity. Serum carboxi terminal cross-linked telopeptide of type I collagen (CTX), osteocalcin (OC) levels, and BMD of lumbar spine and proximal femur were evaluated in 44 males with AS, 18-60 years of age, and compared with those of 39 age-matched healthy men. Men with AS had a significantly lower BMD at the femoral neck and total hip as compared to age-matched controls (all p<0.01). Osteopaenia or osteoporosis was found in 59.5% AS patients at the lumbar spine and in 47.7% at the femoral neck. Mean serum levels of OC and CTX were similar in AS patients and controls. There were no significant differences in BMD and bone turnover markers when comparing subgroups stratified according to disease duration or presence of peripheral arthritis. No correlations were found between disease activity markers and BMD or OC and CTX. In a cohort of relatively young males with AS, we found a high incidence of osteopaenia and osteoporosis. Disease activity and duration did not show any significant influence on BMD or serum levels of OC and CTX.
2021
OBJECTIVE: The aim of this study was to investigate if there is a bias in bone mineral density measurements among major densitometric techniques across multiple skeletal sites. METHODS: In 25 advanced ankylosing spondylitis patients, bone mineral density measurements were acquired in the lumbar spine, the hip, and the forearm. RESULTS: In total, 60% of patients had a bone mineral density Z-score of-2 or less at one or more skeletal sites. Dedicated loss of cortical bone was identified at the distal forearm (60% of patients). Differences in bone mineral density measurements across all densitometric techniques were highly significant (p≤0.001). Bone loss was more striking in spinal trabecular bone by three-dimensional quantitative computed tomography [Z-score-2.1] versus dual-energy X-ray absorptiometry [Z-score 0]. A trabecular bone loss quantified by quantitative computed tomography was about twice as much as a cortical bone loss by single-energy X-ray absorptiometry (p=0.001). CONCLUSIONS: Low bone mineral density is prevalent in advanced ankylosing spondylitis patients, predominating in the spine. Bone mineral density measurements have systematic differences when compared to each other. Knowledge of these offsets is useful for improved diagnosis of regional bone loss that allows for targeted treatment of osteoporosis. Three-dimensional quantitative computed tomography is more suitable for evaluating spinal osteoporosis in advanced ankylosing spondylitis than dual-energy X-ray absorptiometry, which rather underestimates bone loss.
2007
Objective: The aim of this study was to evaluate bone mineral density, osteoporosis and fractures in patients with ankylosing spondylitis (AS) along with related factors like depression, fatigue and quality of life. Materials and Methods: In this prospective, controlled study 38 patients with ankylosing spondylitis and 30 healthy controls were evaluated densitometrically by DXA and quantitative ultrasonography (QUS) of the heel was performed. With the use of DXA, bone mineral densities (BMD) of the proximal femur, tibia and lateral lumbar vertebrae were determined. Dorsal and lumbar radiographs were obtained for morphometric measurements. Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), fatigue scale, Beck Depression Scale and SF-36 were used. Results: In patients L3 t values were significantly lower than controls (p<0.05) with lower femoral neck and total BMD va...