Vertebral Fractures in Ankylosing Spondylitis Are Associated with Lower Bone Mineral Density in Both Central and Peripheral Skeleton

Klingberg, Eva; Geijer, Mats; Göthlin, Jan; Mellström, Dan; Lorentzon, Mattias; Hilme, Elisabet; Hedberg, Martin; Carlsten, Hans; Forsblad-d’Elia, Helena

doi:10.3899/jrheum.120316

Cited by 100 publications

(68 citation statements)

References 34 publications

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“…The reported prevalence rates of osteoporosis in patients with AS range between 19 and 62 %, with this high variability mainly attributed to technical difficulties in assessing spinal bone mineral density, that can result falsely elevated in AS due to ligament ossification, sclerosis of the vertebral margins, and syndesmophytes formation [8,18,[23][24][25][26][27]. More recent prospective data on osteoporosis have shown prevalence rates between 21 and 25 % [10,18,28,29]. Loss of bone mineral density may occur even in early stages of the disease in connection with the inflammation process, independent of spine mobility and exercise [4,7,30].…”

Section: Spinal Remodeling In Asmentioning

confidence: 97%

Spinal fractures in patients with ankylosing spondylitis

Leone¹,

Marino²,

Dell'atti³

et al. 2016

Rheumatol Int

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The ankylosed spine is prone to fracture even after minor trauma due to its changed biomechanical properties. The two central features of ankylosing spondylitis (AS) that promote the pathological remodeling of the spine are inflammation and new bone formation. AS is also associated with osteoporosis that is attributed to an uncoupling of the bone formation and bone resorption processes. Therefore, bone resorption occurs and promotes weakening of the spine as well as increased risk of vertebral fractures which can be hugely different in terms of clinical relevance. Even in the presence of symptomatic clinical vertebral fractures, the diagnosis can be overruled by attributing the pain to disease activity. Furthermore, given the highly abnormal structure of the spine, vertebral fracture diagnosis can be difficult on the basis of radiography alone. CT can show the fractures in detail. Magnetic resonance imaging is considered the method of choice for the imaging of spinal cord injuries, and a reasonable option for exclusion of occult fractures undetected by CT. Since it is equally important for radiologists and clinicians to have a common knowledge base rather than a compartmentalized view, the aim of this review article was to provide the required clinical knowledge that radiologists need to know and the relevant radiological semiotics that clinicians require in diagnosing clinically significant injury to the ankylosed spine.

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Section: Spinal Remodeling In Asmentioning

confidence: 97%

Spinal fractures in patients with ankylosing spondylitis

Leone¹,

Marino²,

Dell'atti³

et al. 2016

Rheumatol Int

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“…Many studies have shown that OP is an important complication of AS that seriously affects the quality of life, even in young patients [3][4][5]32]. Various factors, such as [3,[7][8][9].…”

Section: Discussionmentioning

confidence: 98%

“…Men are more often affected than women, by a ratio of approximately 2-1 [1,2]. Osteoporosis (OP) is a wellknown feature of AS, even in the early, milder stages, and may cause spinal fractures and progressive spinal deformity [3][4][5]. The prevalence of OP in AS ranges from 18.7 to 62 % [6].…”

Section: Introductionmentioning

confidence: 98%

The Relationship of Bone Mineral Density to Oxidant/Antioxidant Status and Inflammatory and Bone Turnover Markers in a Multicenter Cross-Sectional Study of Young Men with Ankylosing Spondylitis

et al. 2015

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Low bone mineral density (BMD) is an important complication of ankylosing spondylitis (AS) that seriously affects men and their quality of life, even in young patients. However, the relationships among redox; levels of bone turnover markers (BTMs), inflammatory markers and disease activity; and low BMD in AS require clarification. We recruited 102 men aged 30-39 year with AS and 102 healthy, sex- and age-matched controls for this cross-sectional study. The subjects were analyzed for lumbar spine and femoral neck BMD by dual-energy X-ray absorptiometry. Significantly lower BMD and corresponding T-scores were observed in the AS patients compared with the controls (P < 0.05). The oxidant biomarker and antioxidant levels were significantly (P < 0.05) higher and lower, respectively, in the AS subjects compared with the controls, and the bone resorption and inflammatory marker levels were higher (P < 0.05). In subgroup analyses, the patients with osteoporosis or active disease had the highest levels of oxidant biomarkers (P < 0.05). Furthermore, the BMD T-scores in AS were found to be negatively correlated with oxidative status (P < 0.05). Multivariate binary logistic analysis showed that low BMD in the AS patients was associated with higher levels of advanced oxidation protein products, malondialdehyde and C-terminal telopeptide of type I collagen; lower levels of glutathione peroxidase; and higher scores of a bath ankylosing spondylitis metrology index. In conclusion, imbalanced redox was independently associated with low BMD in young men with AS and may play an important role in the pathogenesis of AS-related low BMD.

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“…sacroiliac joints in AS or small joints of the hands in PsA. Common complications of AS are osteopenia, osteoporosis, and vertebral fractures, the latter often undiagnosed [5][6][7]. Low bone mineral density and osteoporosis can be detectable already within the first decade of the disease (in 51-54% and 13-16% of patients, respectively) [5].…”

Section: S U M M a R Ymentioning

confidence: 99%

New aspects of spondyloarthritis pathogenesis. Part III – arthritis, pathological bone remodeling

Kontny¹

2014

Reumatologia

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Słowa kluczowe: procesy destrukcyjne, patologiczna przebudowa kości, cytokiny. S t r e s z c z e n i eSpondyloartropatie (SpA) są formą przetrwałego zapalenia stawów obwodowych i kręgosłupa, które może być zapoczątkowane przez zapalenie podchrzęstnego szpiku kostnego w stawach albo zapalenie przyczepów ścięgnistych. Inwazyjna tkanka włóknista zastępu-jąca szpik kostny, rezydujące w przyczepach ścięgnistych limfocyty T o cechach komórek odporności wrodzonej oraz cytokiny: czynnik martwicy nowotworów (tumor necrosis factor -TNF), interleukiny 23, 17 i 22, biorą udział w tych lokalnych procesach patologicznych. Mechanizmy molekularne, które biorą udział w zapaleniu stawów, destrukcji chrząstki i kości stawowej, są podobne do tych w reumatoidalnym zapaleniu stawów i są zatrzymywane przez skuteczną terapię przeciwzapalną, w tym leki biologiczne neutralizujące TNF. Terapie anty-TNF jednak nie hamują patologicznego tworzenia kości, a to zjawisko jest cechą charakterystyczną SpA. Powoduje ono m.in. powstawanie syndesmofitów i ankylozę kręgosłupa. Mechanizmy molekularne leżące u podłoża patologicznej przebudowy kości w SpA, jak również ich interakcje ze szlakami zapalnymi nie są w pełni poznane. Trzy główne omówione w artykule hipotezy są próbą wyjaśnienia tego problemu. S u m m a r ySpondyloarthritis (SpA) is a form of chronic inflammatory arthritis affecting axial and peripheral joints, which may be initiated by inflammation of joint subchondral bone marrow or enthesitis. Invasive fibrous tissue which substitutes bone marrow, entheseal innate-like T lymphocytes and proinflammatory cytokines: tumor necrosis factor (TNF), interleukins 23, 17 and 22, all contribute to these local pathological processes. Joint inflammation, joint cartilage and bone destruction are mediated by mechanisms that are molecularly similar to rheumatoid arthritis. These pathologic processes are halted by effective anti-inflammatory therapy, including anti-TNF biological agents. By contrast, anti-TNF therapy fails to inhibit pathologic new bone formation, which is a unique hallmark of SpA and results, among others things, in syndesmophyte formation followed by spine ankylosis. The molecular mechanisms driving pathologic bone remodeling in SpA patients and interaction of this process with inflammatory pathways are not fully understood. Three hypotheses, discussed in the article, have been proposed to explain this issue.

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Vertebral Fractures in Ankylosing Spondylitis Are Associated with Lower Bone Mineral Density in Both Central and Peripheral Skeleton

Cited by 100 publications

References 34 publications

Spinal fractures in patients with ankylosing spondylitis

Spinal fractures in patients with ankylosing spondylitis

The Relationship of Bone Mineral Density to Oxidant/Antioxidant Status and Inflammatory and Bone Turnover Markers in a Multicenter Cross-Sectional Study of Young Men with Ankylosing Spondylitis

New aspects of spondyloarthritis pathogenesis. Part III – arthritis, pathological bone remodeling

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