Femur Bone Mineral Density and Pentosidine Level Distinguish Ankylosing Spinal Disorder Patients with and without Sacroiliac Ankylosis

Abstract

Introduction: When spinal fracture occurred in ankylosing spinal disorder (ASD) patients, it is important to evaluate not only the long lever arm but also bone density and bone quality for the determination of treatment strategies. This case-controlled study examined bone mineral density (BMD), bone metabolism markers, and pentosidine levels in patients with ASD.Methods: Subjects with bridging of minimum four contiguous vertebral bodies were classified into ASD group and the rest into non-ASD group. The former was further divided into two subgroups based on the presence/absence of sacroiliac joint ankylosis (SJA). We compared BMD, bone metabolism markers, and pentosidine levels in these groups. Results:The BMD T and Z scores of the femur proximal extremity were lower in the ASD with SJA group than those in the ASD without SJA group. When groups were matched for age, weight, and eGFR, compared with the non-ASD group, the ASD with SJA group had lower BMD of the lumbar spine and femur proximal extremity and the ASD without SJA group had significantly higher BMDs of the lumbar spine and femur proximal extremity. After matching, the ASD without SJA group showed a significantly higher pentosidine level than the non-ASD group. Conclusions:Patients with SJA have low femur proximal extremity BMD, whereas those with ASD without SJA have a higher BMD of the femur proximal extremity with high pentosidine level.

Association of Continuous Vertebral Bone Bridges and Bone Mineral Density with the Fracture Risk in Patients with Diffuse Idiopathic Skeletal Hyperostosis

“…Another report wherein DEXA was used on cadavers in directions that did not include the bone bridge found no difference in the BMD of the lumbar spine and that of the controls, indicating that the bone bridge leads to an overestimation of the BMD [ 14 , 21 ]. In contrast, two studies reported significantly higher BMD of the femur neck in DISH patients than that in the general population matched for some factors, including age, sex, and weight [ 22 , 23 ].…”

Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion-

“…Postoperative back pain scores and Barthel indices were obtained at the postoperative visit and by telephone interview. BMD was assessed by the total proximal femur because the lumbar spine cannot be accurately measured in the presence of bony bridging (GE Medical Systems Lunar) [ 24 ]. The maxVB was defined as the maximum number of consecutive bone bridges between the adjacent vertebra from the thoracic to the lumbar spine (Fig.…”

“…The medications for osteoporosis were selected from among bone formation stimulants (parathyroid hormone), bone resorption inhibitors (bisphosphonate, an anti-receptor activator of nuclear factor-kappa B ligand antibody, and a selective oestrogen receptor modulator), and others (romosozumab and 1,25 dihydroxyvitamin D3). Bone fusion was determined via sagittal and coronal CT scans, which revealed bone bridging between the vertebral bodies and the presence of bone fusion between the autograft bone or expandable cages and the upper and lower vertebral bodies [ 24 – 26 ]. In the present study, the presence of bone fusion on both cephalocaudal sides was defined as good bone fusion (for vertebrae with residual endplates, lateral fusion of the remaining vertebrae and the grafted bone was also considered fusion), while the presence of bone fusion on only one side or the absence of bilateral bone fusion was defined as poor bone fusion.…”