FRI0196 Traditional dxa underestimates bone mineral density of the spine in axial spondyloarthropathy

Abstract

BackgroundAxial spondyloarthropathy (axSpA) is an inflammatory arthritis which can lead to new bone formation (syndesmophytes) and ankylosis of the spine. Osteoporosis is a recognised feature of axSpA, but can be challenging to diagnose. Traditional dual-energy x-ray absorptiometry (DXA) in the antero-posterior (AP) projection of the spine can overestimate bone mineral density (BMD) due to the presence of syndesmophytes, potentially under-diagnosing osteoporosis. There is a real need to find an accurate method to assess BMD in axSpA patients. Lateral DXA of the lumbar spine is unaffected by syndesmophyte formation and may be a promising tool.ObjectivesThe aim of this study is to:1. investigate different projections of DXA of the lumbar spine in axSpA patients2. assess the effect of syndesmophytes on spine BMD.MethodsAxSpA patients were assessed with clinical exam, questionnaires and laboratory investigations. The burden of syndesmophytes on lateral x-rays of the lumbar and cervical spine was assessed with the validated modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) score, which ranges from 0–72 (higher scores indicate more severe disease). DXA was performed of the spine in both the AP and lateral projections. SPSS was used for statistical analysis.ResultsOne hundred patients with axSpA were recruited: 78% (n=78) male, mean (SD) age 5212 years, disease duration 2613 years, 85% (n=85) fulfil modified New York criteria. The median (IQR) mSASSS score was 10.33 Lumbar spine BMD was lower when measured by lateral DXA rather than AP (0.76 v 1.11 g/cm2, p<0.01). Lateral DXA detected more cases of spinal osteopenia or osteoporosis than AP (21% v 44%, p<0.01). Lateral spine BMD reduced with longer duration of disease (r=-0.3, p=0.02), whereas AP spine BMD increased with age (r=0.3, p=0.01). Women had significantly more cases of osteoporosis at the lumbar spine than men when measured by lateral DXA (32% v 12%, p=0.02), but not by AP DXA.A higher mSASSS, reflecting more syndesmophytes/new bone formation, was associated with a rising AP spine BMD (r=0.5, p<0.01), but had no effect on lateral spine BMD. The gap between AP and lateral spine BMD, i.e. when AP BMD was higher than lateral BMD, increased significantly (p<0.05) with increasing age (r=0.38), disease duration (r=0.37) and mSASSS (r=0.52). mSASSS was the strongest independent predictor of a difference between AP and lateral BMD measurements, suggesting that syndesmophyte formation interferes with AP DXA assessment of the spine.ConclusionsAP DXA of the spine is affected by a higher burden of syndesmophytes (new bone formation), raising concerns that traditional DXA assessment may miss cases of osteoporosis. We suggest that lateral DXA of the spine may be a more accurate tool to detect osteoporosis in axSpA patients.Disclosure of InterestNone declared