Osteoporosis in Early Ankylosing Spondylitis: A Primary Pathological Event?

Will, R.; Palmer, Robert E. A.; Bhalla, Ashish; Ring, Francis; Calin, Andrei

doi:10.1016/s0140-6736(89)92932-2

Cited by 184 publications

(95 citation statements)

References 10 publications

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“…We also found significant positive correlation between disease duration and lumbar spine BMD. Moreover, we found that bone loss of the femoral neck was proportional to disease duration, in keeping with previous reports (4,24,28,30). Some investigators reported no significant correlation between disease duration and BMD at both the lumbar spine and femoral neck (18,28,30,31).…”

Section: Discussionsupporting

confidence: 92%

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

et al. 2010

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Objective: This retrospective study was planned to determine the relationship between bone mineral density (BMD) and clinical, radiological and laboratory parameters in patients with ankylosing spondylitis (AS). Materials and Methods:The study group consisted of 28 patients with a mean disease duration of 11.9±6.1 years. In addition to clinical and demographic variables, lumbar and femoral BMD were evaluated with dual energy X-ray absorbtiometry. Lumbar spine score (LSS) and sacroiliac score (SIS) were calculated by grading of standard radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were determined as laboratory parameters. Results: The rate of osteoporosis and osteopenia were 7.1% and 25% at the lumbar spine, and 14.2% and 17.8% at the femoral neck, respectively. LSS was significantly correlated with lumbar BMD (r=0.70, p<0.001), but not with femoral neck BMD (r=-0.11, p=0.55). SIS was negatively correlated with femoral neck BMD (r=-0.79, p<0.001), but not correlated with lumbar BMD (r=0.19, p=0.32). While lumbar BMD was positively correlated with disease duration (r=0.37, p=0.05), femoral neck BMD showed negative correlation with disease duration (r=-0.46, p=0.01). The evaluation of clinical paramaters and BMD showed that morning stiffness, spinal pain, ESR and CRP were not correlated with BMD. Only modified Schober's test was related to BMD on both lumbar spine and femoral neck. Conclusion: Ankylosing spondylitis patients are at risk for developing osteoporosis. In advanced disease, the lumbar BMD is misleadingly high because of paravertebral calcification and ossification. Therefore, it is more rational to evaluate the BMD at the femoral neck. (Turk J Rheumatol 2010; 25: 24-8

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Section: Discussionsupporting

confidence: 92%

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

et al. 2010

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“…1). 21,26,43 This seemingly paradoxical finding is attributed to an uncoupling of the bone formation and bone resorption processes. Therefore, although ectopic bone formation occurs within the inflamed vertebral enthesis, bone resorption, through increased osteoclast activity, also occurs at an unregulated rate within the vertebra and promotes weakening of the spinal column.…”

mentioning

confidence: 99%

Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance

Jacobs¹,

Fehlings²

2008

FOC

139

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✓ Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that primarily affects the vertebral column and sacroiliac joints. Over time, the disease process promotes extensive remodeling of the spinal axis via ligamentous ossification, vertebral joint fusion, osteoporosis, and kyphosis. These pathological changes result in a weakened vertebral column with increased susceptibility to fractures and spinal cord injury (SCI). Spinal cord injury is often exacerbated by the highly unstable nature of vertebral column fractures in AS. A high incidence of missed fractures in the ankylosed spine as well as an increased incidence of spinal epidural hematoma also worsens the severity of SCI. Spinal cord injury in AS is a complex problem associated with high morbidity and mortality rates, which can be attributed to the severity of the injury, associated medical comorbidities, and the advanced age of most patients with AS who suffer an SCI. In this paper the authors outline the factors that increase the incidence of vertebral column fractures and SCI in AS and discuss the management of SCI in patients with AS. Primary prevention strategies for SCI in patients with AS are outlined as well.

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“…Evidence also showed that patients with vitamin D deficiency may have an increased risk of immune-mediated inflammatory diseases including AS [10], with further inflammatory activity in SpA patients indirectly linked with vitamin D deficiency and predisposition to the development of osteoporosis, which can be considered as early phase of osteomalacia. Furthermore, some studies also revealed that low plasma levels of serum 25(OH)D were presented in AS patients when compared to healthy control [11,12]. Our study showed 25(OH)D was significantly lower in axSpA patients (25.06 ± 10.06 ng/ml) compared to borderline to the normal level (34.90 ± 12.57 ng/ml) in the control group, consistent with the previous study of Baskan et al [13].…”

Section: Discussion:-mentioning

confidence: 99%

Correlation of Vitamin D Deficiency and Sub-Clinical Osteomalacia in Axial Spondyloarthropathy.

Virdi¹,

Singh²,

Kaur³

et al. 2017

IJAR

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Introduction:Recently vitamin D deficiency has been linked to autoimmune, inflammatory and carcinogenic diseases. In autoimmune diseases, vitamin D deficiency might be associated with risk of both susceptibility and severity of the bone mineral density. Objective: Our study aims at finding vitamin D deficiency in axial spondyloarthropathy and its effect on bone integrity. Material: We compared 95 axial spondyloarthropathy patients and 75 control patients regarding Vit-D levels, bone markers, CRP, ALP, PTH, BMD and sunshine exposure. Conclusion:We conclude significant correlation between vitamin D deficiency and axial spondyloarthropathy and significantly lower femoral neck T and Z scores in BMD than controls.

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Osteoporosis in Early Ankylosing Spondylitis: A Primary Pathological Event?

Cited by 184 publications

References 10 publications

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance

Correlation of Vitamin D Deficiency and Sub-Clinical Osteomalacia in Axial Spondyloarthropathy.

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