The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis

Abstract

In this study, the relation between osteoporosis and vitamin D and the disease activity in patients with ankylosing spondylitis (AS) was investigated. A hundred patients with AS and 58 healthy individuals were included in the study. In addition to the routine blood and urine tests, serum 25-(OH)D3, parathormone (PTH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total calcium, ionized calcium, and phosphorous levels of all participants were also measured. Bone mineral density (BMD) measurements were performed at the anterior-posterior and lateral lumbar and femur regions. Anterior-posterior and lateral thoracic and lumbosacral radiography was performed on all participants. The disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by Bath Ankylosing Spondylitis Functional Index (BASFI), and mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI). In the patient group, BMD values obtained from the lateral lumbar and femur regions and serum vitamin D levels were lower than the control group. A negative relation was determined between the lateral lumbar BMD values and ESR, CRP, and BASDAI scores of patients with AS. The ESR, CRP levels, and BASMI scores of the AS patients with osteoporosis were significantly higher, when compared to patients without osteoporosis. The negative correlation between serum 25-(OH)D3 level and ESR, CRP levels did not reach a statistically significant level in patients with AS; the positive correlation between PTH levels and ESR, and the negative correlation between CRP and BASDAI also did not reach a statistically significant level. Vitamin D deficiency in AS may indirectly lead to osteoporosis by causing an increase in the inflammatory activity. The present authors believe that it would be beneficial to monitorize vitamin D levels together with BMD measurements in order to determine the patients under osteoporosis risk.

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

“…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]. In our axSpA patients, serum 25(OH)D levels found normal levels in 26 (28%), insufficient in 34 (36%), and deficient in 30 (32%) and severely deficient in 4 (4%) compared with a distribution in healthy controls of 45 (61%), 20 (27%), 8 (11%) and 1 (1%) respectively.…”

“…Although vitamin D concentrations were not associated with higher disease activity in our study, vitamin D levels were significantly lower in axSpA patients. Furthermore, AS patients with osteoporosis it has been shown that the levels of PTH are significantly elevated [13]. In our study axSpA patients serum level of PTH was elevated but not significantly different when compared with healthy control.…”

“…Besides BMD T/Z-score has significant differences between axSpA patients and healthy control group, furthermore, axSPA patients femoral and lumbar BMD Z-scores were negatively correlated with active inflammatory marker such as CRP, ESR and disease activity ASDAS, bone turnover marker sCTX and OC (Table 4). Consistently, the acute phase reactant ESR and CRP was significantly elevated and inversely correlated with vitamin D levels in AS patients [13], disease activity ASDAS was negatively correlated with BMD because of vitamin D receptor gene may contribute to BMD differences in patients with AS, as gene polymorphisms are also linked to inflammatory activity [18]. Thus, osteoporotic risk may be significantly increased with raised serum levels of bone turnover markers and low levels of vitamin D. Previous study also has shown that the relationship between vitamin D with CRP and ESR, were significantly negatively correlated [19].…”

Nutritional aspects and vitamin D supplementation in ankylosing spondylitis

“…While several studies had shown the aggravating effect of vitamin D's deficiency in the activity markers of AS disease [61][62][63][64] , other studies have not found any correlation [65][66][67] . Although, there is evidence for increased risk of AS in people with deficiency of vitamin D [68][69][70] further studies are required to clarify the causal relationship between the deficiency of vitamin D and activity of AS disease.…”

Association of Vitamin D with Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis

“…Furthermore, it was shown that vitamin D addition prevented the onset and progress of inflammatory arthritis in rats [7,8]. However, there are different opinions about the relationship between vitamin D levels and disease activities in RA and AS patients in the literature [9][10][11][12][13][14][15][16][17].…”