Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study
Abstract Background Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Arthritis Research & Therapy |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13075-017-1480-0 |
| _version_ | 1819138592290635776 |
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| author | Anna Deminger Eva Klingberg Mattias Lorentzon Mats Geijer Jan Göthlin Martin Hedberg Eva Rehnberg Hans Carlsten Lennart T. Jacobsson Helena Forsblad-d’Elia |
| author_facet | Anna Deminger Eva Klingberg Mattias Lorentzon Mats Geijer Jan Göthlin Martin Hedberg Eva Rehnberg Hans Carlsten Lennart T. Jacobsson Helena Forsblad-d’Elia |
| author_sort | Anna Deminger |
| collection | DOAJ |
| description | Abstract Background Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes. Methods In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes. Results Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = –0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012). Conclusion The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients. |
| first_indexed | 2024-12-22T11:09:13Z |
| format | Article |
| id | doaj.art-cc7db3c3019e48f897749759afd00feb |
| institution | Directory Open Access Journal |
| issn | 1478-6362 |
| language | English |
| last_indexed | 2024-12-22T11:09:13Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
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| series | Arthritis Research & Therapy |
| spelling | doaj.art-cc7db3c3019e48f897749759afd00feb2022-12-21T18:28:12ZengBMCArthritis Research & Therapy1478-63622017-12-0119111210.1186/s13075-017-1480-0Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective studyAnna Deminger0Eva Klingberg1Mattias Lorentzon2Mats Geijer3Jan Göthlin4Martin Hedberg5Eva Rehnberg6Hans Carlsten7Lennart T. Jacobsson8Helena Forsblad-d’Elia9Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of GothenburgDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of GothenburgGeriatric Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University HospitalDepartment of Radiology, Faculty of Medicine and Health, Örebro UniversityDepartment of Radiology, Sahlgrenska University Hospital/MölndalSection of Rheumatology, Södra Älvsborg HospitalSection of Rheumatology, Alingsås HospitalDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of GothenburgDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of GothenburgDepartment of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of GothenburgAbstract Background Studies have shown increased prevalence of osteoporosis and increased risk for vertebral fractures in patients with ankylosing spondylitis (AS). Measurements of bone mineral density (BMD) in the lumbar spine anterior-posterior (AP) projection may be difficult to interpret due to the ligamentous calcifications, and the lateral projection might be a better measuring site. Our objectives were to investigate BMD changes after 5 years at different measuring sites in patients with AS and to evaluate disease-related variables and medications as predictors for BMD changes. Methods In a longitudinal study, BMD in Swedish AS patients, 50 ± 13 years old, was measured with dual-energy x-ray absorptiometry (DXA) at the hip, the lumbar spine AP and lateral projections, and the total radius at baseline and after 5 years. Patients were assessed with questionnaires, blood samples, and spinal radiographs for grading of AS-related alterations in the spine with the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and assessment of vertebral fractures by the Genant score. Multiple linear regression analyses were used to investigate predictors for BMD changes. Results Of 204 patients included at baseline, 168 (82%) were re-examined after 5 years (92 men and 76 women). BMD decreased significantly at the femoral neck and radius and increased significantly at the lumbar spine, both for AP and lateral projections. Mean C-reactive protein during follow-up predicted a decrease in the femoral neck BMD (change in %, β = –0.15, p = 0.046). Use of bisphosphonates predicted an increase in BMD at all measuring sites (p < 0.001 to 0.013), except for the total radius. Use of tumor necrosis factor inhibitors (TNFi) predicted an increase in AP spinal BMD (β = 3.15, p = 0.012). Conclusion The current study (which has a long follow-up, many measuring sites, and is the first to longitudinally assess the lateral projection of the spine in AS patients) surprisingly showed that lateral projection spinal BMD increased. This study suggests that the best site to assess bone loss in AS patients is the femoral neck and that inflammation has an adverse effect, and the use of bisphosphonates and TNFi has a positive effect, on BMD in AS patients.http://link.springer.com/article/10.1186/s13075-017-1480-0Ankylosing spondylitisOsteoporosisBone mineral densityInflammationLongitudinal study |
| spellingShingle | Anna Deminger Eva Klingberg Mattias Lorentzon Mats Geijer Jan Göthlin Martin Hedberg Eva Rehnberg Hans Carlsten Lennart T. Jacobsson Helena Forsblad-d’Elia Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study Arthritis Research & Therapy Ankylosing spondylitis Osteoporosis Bone mineral density Inflammation Longitudinal study |
| title | Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study |
| title_full | Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study |
| title_fullStr | Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study |
| title_full_unstemmed | Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study |
| title_short | Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study |
| title_sort | which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline results from a 5 year prospective study |
| topic | Ankylosing spondylitis Osteoporosis Bone mineral density Inflammation Longitudinal study |
| url | http://link.springer.com/article/10.1186/s13075-017-1480-0 |
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