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Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment

Klingberg, Eva; Lorentzon, Mattias; Mellstrom, Dan; Geijer, Mats LU ; Gothlin, Jan; Hilme, Elisabet; Hedberg, Martin; Carlsten, Hans and Forsblad-d'Elia, Helena (2012) In Arthritis Research and Therapy 14(3).
Abstract
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... (More)
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). Results: AS patients (modified New York criteria), 87 women and 117 men, mean age 50 +/- 13 years and disease duration 15 +/- 11 years were included. According to World Health Organization (WHO) criteria 21% osteoporosis and 44% osteopenia was diagnosed in patients > = 50 years. Under age 50 BMD below expected range for age was found in 5%. Interestingly lateral lumbar DXA showed significantly lower BMD and revealed significantly more cases with osteoporosis as compared with AP DXA. Lumbar vBMD was not different between sexes, but women had significantly more lumbar osteoporosis measured with AP DXA (P < 0.001). Men had significantly higher mSASSS (P < 0.001). Low BMD was associated with high age, disease duration, mSASSS, Bath Ankylosing Spondylitis Metrology Index (BASMI), inflammatory parameters and low body mass index (BMI). Increasing mSASSS correlated significantly with decreasing lateral and volumetric lumbar BMD, while AP lumbar BMD showed tendency to increase. Conclusions: Osteoporosis and osteopenia is common in AS and associated with high disease burden. Lateral and volumetric lumbar DXA are more sensitive than AP DXA in detecting osteoporosis and are less affected by syndesmophyte formation. (Less)
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author
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publishing date
type
Contribution to journal
publication status
published
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in
Arthritis Research and Therapy
volume
14
issue
3
publisher
BioMed Central
external identifiers
  • wos:000314972600010
  • scopus:84860605484
ISSN
1478-6362
DOI
10.1186/ar3833
language
English
LU publication?
yes
id
8b9899d4-ede9-4cfe-a5b2-75a7183ad8e3 (old id 3577408)
date added to LUP
2013-04-02 07:44:36
date last changed
2017-10-01 03:00:33
@article{8b9899d4-ede9-4cfe-a5b2-75a7183ad8e3,
  abstract     = {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). Results: AS patients (modified New York criteria), 87 women and 117 men, mean age 50 +/- 13 years and disease duration 15 +/- 11 years were included. According to World Health Organization (WHO) criteria 21% osteoporosis and 44% osteopenia was diagnosed in patients &gt; = 50 years. Under age 50 BMD below expected range for age was found in 5%. Interestingly lateral lumbar DXA showed significantly lower BMD and revealed significantly more cases with osteoporosis as compared with AP DXA. Lumbar vBMD was not different between sexes, but women had significantly more lumbar osteoporosis measured with AP DXA (P &lt; 0.001). Men had significantly higher mSASSS (P &lt; 0.001). Low BMD was associated with high age, disease duration, mSASSS, Bath Ankylosing Spondylitis Metrology Index (BASMI), inflammatory parameters and low body mass index (BMI). Increasing mSASSS correlated significantly with decreasing lateral and volumetric lumbar BMD, while AP lumbar BMD showed tendency to increase. Conclusions: Osteoporosis and osteopenia is common in AS and associated with high disease burden. Lateral and volumetric lumbar DXA are more sensitive than AP DXA in detecting osteoporosis and are less affected by syndesmophyte formation.},
  articleno    = {R108},
  author       = {Klingberg, Eva and Lorentzon, Mattias and Mellstrom, Dan and Geijer, Mats and Gothlin, Jan and Hilme, Elisabet and Hedberg, Martin and Carlsten, Hans and Forsblad-d'Elia, Helena},
  issn         = {1478-6362},
  language     = {eng},
  number       = {3},
  publisher    = {BioMed Central},
  series       = {Arthritis Research and Therapy},
  title        = {Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment},
  url          = {http://dx.doi.org/10.1186/ar3833},
  volume       = {14},
  year         = {2012},
}