Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis

Abstract

Vertebral fractures due to osteoporosis are a common but frequently unrecognized complication in established ankylosing spondylitis (AS). It is known that inflammatory activity in rheumatic diseases (i.e., proinflammatory cytokines) itself plays a possible role in the pathophysiology of bone loss. The aim of this study was to analyze whether inflammatory activity and an alteration of the vitamin D metabolism play a substantial role in the loss of bone mass in AS. In this cross-sectional study, 58 patients with established AS and an age- and sex-matched control group were examined. The vitamin D status was investigated, as was, in parallel, the relationship to disease activity (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), markers of bone metabolism (parathyroid hormone [PTH], 1.25 vitamin D3, 25 vitamin D3), calcium, bone alkaline phosphatase (bone-AP), urine cross-links, and plasma tumor necrosis factor alpha (TNFalpha). Bone mineral density was measured by quantitative computed tomography (QCT) of the lumbar spine. Osteoporosis was diagnosed in early as well as in progressive stages of AS (23/58=39.6%). Furthermore, serum levels of 1.25 vitamin D3 and PTH were negatively correlated with disease activity and TNFalpha. The excretion of cross-links showed a positive correlation with disease activity and TNFalpha, and 1.25 vitamin D3 and PTH were positively correlated with bone-AP. TNFalpha also positively correlated with disease activity. AS patients with osteoporosis showed significantly increased CRP, ESR, cross-links and PTH and a significantly decreased 1.25 D3. Osteoporosis is frequent in AS and high disease activity is associated with an alteration in vitamin D metabolites and increased levels of bone resorption in active AS. Our findings propose a close association of BMD, bone metabolism and inflammatory activity, possibly related to vitamin D inflammation interactions.

Relationship of bone mineral density with disease activity and functional ability in patients with ankylosing spondylitis: a cross-sectional study

“…There are other studies which also showed the same relationship between disease activity parameters (ESR, CRP levels and BASDAI) and bone density indicating that bone loss in AS is predominantly the consequence of inflammatory mediators' action [22][23][24][25][26].…”

Nutritional aspects and vitamin D supplementation in ankylosing spondylitis

“…While several studies had shown the aggravating effect of vitamin D's deficiency in the activity markers of AS disease [61][62][63][64] , other studies have not found any correlation [65][66][67] . Although, there is evidence for increased risk of AS in people with deficiency of vitamin D [68][69][70] further studies are required to clarify the causal relationship between the deficiency of vitamin D and activity of AS disease.…”

“…Additionally, Hmamouchi et al in another study, with 653 axSpA patients, mentioned that 25(OH)D had a significant inverse correlation with AS disease activity score, using CRP and Bath Ankylosing Spondylitis Metrology Index (BASMI) 73 . In studies that examined the relationship of 1,25(OH) 2 D with disease activity markers, found a significant inverse correlation between 1,25(OH) 2 D and ESR, BASDAI and CRP 63,64 . In contrast, there are studies that indicated that there is no correlation between 25(OH)D and disease activity [74][75][76] .…”

Vitamin D Levels in Patients With Ankylosing Spondylitis and Its Relationship With Disease Activity

“…Therefore, factors affecting the immune system may have effects on the disease course. One of these factors affecting the immune system is vitamin D. 2 The relationship between serum vitamin D levels and disease activity scores in patients with AS has been studied in a number of studies [3][4][5] with varying results. Based on this controversy, we aimed to elucidate the relationship between serum vitamin D levels and disease activity scores in AS patients as well as to compare vitamin D levels of AS patients with healthy individuals.…”

“…There was no significant correlation between vitamin D levels and BASDAI scores (r= -0.035, p=0.765). Although the relationship between serum vitamin D levels and disease activity in AS has been studied in a number of studies, [3][4][5] only one study showed a relationship between 25-OH-D levels and disease activity. 4 Lange et al 5 reported a correlation between disease activity in AS and 1,25-OH-D metabolites levels; however, not with 25-OH-D. We used 25-OH-D which is the major circulating form of vitamin D.…”