High-resolution Quantitative Computed Tomography Demonstrates Structural Defects in Cortical and Trabecular Bone in IBD Patients

Haschka, Judith; Hirschmann, Simon; Kleyer, Arnd; Englbrecht, Matthias; Faustini, Francesca; Simón, David; Figueiredo, C.; Schuster, Louis; Muschitz, Christian; Kocijan, Roland; Resch, Heinrich; Atreya, Raja; Rech, Jürgen; Neurath, Markus F.; Schett, Georg

doi:10.1093/ecco-jcc/jjw012

Cited by 28 publications

(24 citation statements)

References 43 publications

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“…Total, trabecular and cortical volumetric bone density in patients with RA+ were lower than those previously described in ankylosing spondylitis, 36 40 inflammatory bowel diseases, 41 psoriatic arthritis and psoriasis 42 or even osteogenesis imperfecta. 43 Similarl compromised bone was only described in postmenopausal women with fractures 16 28 44 and for men with pathological fractures.…”

Section: Discussioncontrasting

confidence: 64%

Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures

Stemmler

Simón

Liphardt

et al. 2018

Annals of the Rheumatic Diseases

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ObjectivesBone loss is a well-established consequence of rheumatoid arthritis (RA). To date, bone disease in RA is exclusively characterised by bone density measurements, while the functional properties of bone in RA are undefined. This study aimed to define the impact of RA on the functional properties of bone, such as failure load and stiffness.MethodsMicro-finite element analysis (µFEA) was carried out to measure failure load and stiffness of bone based on high-resolution peripheral quantitative CT data from the distal radius of anti-citrullinated protein antibody (ACPA)-positive RA (RA+), ACPA-negative RA (RA−) and healthy controls (HC). In addition, total, trabecular and cortical bone densities as well as microstructural parameters of bone were recorded. Correlations and multivariate models were used to determine the role of demographic, disease-specific and structural data of bone strength as well as its relation to prevalent fractures.Results276 individuals were analysed. Failure load and stiffness (both P<0.001) of bone were decreased in RA+, but not RA−, compared with HC. Lower bone strength affected both female and male patients with RA+, was related to longer disease duration and significantly (stiffness P=0.020; failure load P=0.012) associated with the occurrence of osteoporotic fractures. Impaired bone strength was correlated with altered bone density and microstructural parameters, which were all decreased in RA+. Multivariate models showed that ACPA status (P=0.007) and sex (P<0.001) were independently associated with reduced biomechanical properties of bone in RA.ConclusionIn summary, µFEA showed that bone strength is significantly decreased in RA+ and associated with fractures.

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Section: Discussioncontrasting

confidence: 64%

Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures

Stemmler

Simón

Liphardt

et al. 2018

Annals of the Rheumatic Diseases

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“…For example, patients with rheumatoid arthritis had profoundly diminished values in the cortical and trabecular bone compartment compared with the respective control group . Patients with inflammatory bowel disease including Crohn's diseases and ulcerative colitis demonstrated a predominant cortical bone loss . On the other hand, psoriasis and psoriatic arthritis were accompanied by a more pronounced trabecular bone loss; both diseases are linked to pro‐inflammatory actions of IL‐17, and mechanistically, the bone loss was previously attributed to IL‐17‐mediated disturbance of WNT signaling in osteoblasts .…”

Section: Discussionmentioning

confidence: 99%

Disease Duration and Stage Influence Bone Microstructure in Patients With Primary Biliary Cholangitis

Schmidt

et al. 2018

Journal of Bone and Mineral Research

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Primary biliary cholangitis (PBC) is known to be a major risk factor for osteoporosis reflected by a reduction of bone mineral density (BMD). However, both the extent of the macro- and microstructural alterations of bone as well as the causative factors are unknown. We have retrospectively analyzed a total of 96 patients with PBC and 53 healthy controls matched for age, sex, and body mass index. In addition to dual-energy X-ray absorptiometry (DXA) measurements at the lumbar spine and hip, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to assess the geometric, volumetric, and microstructural changes of bone at the distal radius and tibia. Furthermore, serum analyses and measures of disease duration and stage including transient elastography were performed. Total, cortical, and trabecular volumetric BMD as well as geometric parameters were significantly reduced in PBC patients. Microstructural analysis revealed a significantly lower cortical thickness (p < 0.001) and bone volume per tissue volume (p < 0.001) in the radius and tibia but unchanged trabecular number in patients with PBC (radius: p = 0.42; tibia: p = 0.12). Multivariate regression models pointed out that disease duration and stage are the primary factors that are independently associated with bone loss in PBC. A subgroup analysis of patients with additional autoimmune hepatitis (AIH) revealed no significant changes in bone structure compared with PBC only. Taken together, PBC patients demonstrate severe alterations in bone microstructure that are positively associated with disease duration and stage. By applying HR-pQCT in the distal radius and tibia, a combined bone loss syndrome expressed by a predominant decrease in BMD and cortical thickness could be detected. © 2018 American Society for Bone and Mineral Research.

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“…Inflammatory diseases that affect joints, skin and the gutincluding rheumatoid arthritis (RA), psoriatic arthritis (PsA), and Crohn's disease -also promote bone loss that is often severe (1)(2)(3). Inflammation-driven bone degradation affects the axial and appendicular skeleton early in life and enhances the risk of fracture.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory osteolysis: a conspiracy against bone

Mbalaviele¹,

Novack

Schett

et al. 2017

Journal of Clinical Investigation

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178

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High-resolution Quantitative Computed Tomography Demonstrates Structural Defects in Cortical and Trabecular Bone in IBD Patients

Abstract: IBD patients develop significant cortical bone loss, impairing bone strength. Trabecular bone loss is limited to CD patients, who exhibit a more severe bone phenotype compared with UC patients.

Cited by 28 publications

References 43 publications

Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures

Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures

Disease Duration and Stage Influence Bone Microstructure in Patients With Primary Biliary Cholangitis

Inflammatory osteolysis: a conspiracy against bone

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