Bone edema on magnetic resonance imaging is highly associated with low bone mineral density in patients with ankylosing spondylitis

Abstract

ObjectiveThis study aimed to assess the relationship between bone marrow edema (BME) on magnetic resonance imaging (MRI) and bone mineral density (BMD) in patients with ankylosing spondylitis (AS).MethodsThe study included 333 patients with AS who underwent BMD measurements and axial MRI. Additionally, 106 normal controls were included. The modified New York criteria were used as the classification criteria of AS. Clinical, laboratory, and imaging data were collected and analyzed. Lumbar spine and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Low BMD was defined by a Z-score ≤-2. The Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index was used to assess inflammation at the sacroiliac joint (SIJ) and spine.ResultsAmong the 333 patients, the male:female ratio was 4.6:1, mean patient age was 28.5±10.6 years, and mean disease duration was 7.3±6.8 years. The prevalences of low BMD, osteopenia, and osteoporosis were significantly higher among AS patients than among controls (19.8%, 62.8%, and 5.7% vs. 4.7%, 33.0%, and 0%, respectively, P = 0.000). The BMD values were significantly lower and prevalences of low BMD at both the spine and femur were significantly higher among patients with BME on MRI than among those without BME. Multivariate logistic regression analysis showed that male sex (OR 3.87, 95% CI 1.21–7.36, P = 0.023), high ASDAS-CRP score (OR 2.83, 95% CI 1.36–4.76, P = 0.015), the presence of BME on sacroiliac MRI (OR 2.83, 95% CI 1.77–6.23, P = 0.000) and spinal MRI (OR 4.06, 95% CI 1.96–8.46, P = 0.000), and high grade of sacroiliitis (OR 2.93, 95% CI 1.82–4.45, P = 0.002) were risk factors for low BMD (any site). The SPARCC scores of the SIJ were negatively correlated with femoral BMD (r = -0.22, 95% CI -0.33 to -0.10, P = 0.000). Additionally, the SPARCC scores of the spine were negatively correlated with BMD values (r = -0.23, 95% CI -0.36 to -0.09, P = 0.003) and Z-scores (r = -0.24, 95% CI -0.36 to -0.12, P = 0.001) at the spine.ConclusionLow BMD is common in AS patients. BME on MRI is highly associated with low BMD at both the spine and femur.

The Effect of Inflammation on Bone

“…Several studies have determined its efficacy in measuring bone resorption in response to inflammation. One study compared bone marrow edema (BME)—inflammation of bone marrow—seen on MR images to levels of inflammation and BMD in patients with ankylosing spondylitis (AS), a chronic systemic inflammatory disease ( Wang et al, 2017 ). From this study, it was determined that MRI-based imaging was effective in showing high BME in areas of low BMD and high inflammation.…”

Disorders of Structural and Functional State of Bone Tissue in Men With Ankylosing Spondylitis, Their Relation to Disease Course

“…According to the data of Van Der Weijden M., osteopenia at the level of the lumbar spine was found in 54% of the patients, osteoporosis was found in 13% [8]. In the study of Wang D. et al, osteoporosis was found only in 5,7% and osteopenia was found in 62,8% of the patients [9]. In our opinion, such variability of results probably depends on the peculiarities of the examined populations (age, sex, duration of AS), different approaches to the evaluation of the level of decrease in BMD and methods of its determination.…”

A Prognostic Nomogram for Postoperative Bone Remodeling in Patients with ADDWoR

“…In our study, the condyle condition (BMD) was composed of two indexes. According to the International Society of Clinical Densitometry (ISCD), the value of the lumbar spine (anterior-posterior at L2–L4) and proximal femur (femoral neck, trochanter, and Ward’s triangle) was measured using dual-energy X-ray absorptiometry (DEXA, DMS Lessos, France) in which a Z-score ≤ −2 was termed as low 14 , 15 . Besides, a condyle osteopenia was also measured using MRI examination in which a hypointense signal instead of a normal hyperintense signal was detected on T1 images of bone marrow area.…”

“…Besides, a condyle osteopenia was also measured using MRI examination in which a hypointense signal instead of a normal hyperintense signal was detected on T1 images of bone marrow area. The ‘osteopenia’ changes were required to present on at least two consecutive slices 14 , 16 .…”