Risk Factors of Bone Loss in Spondyloarthritis
-
Wafa Hamdi
,
Meriem Sellami
,
Abir Kasraoui
,
Kaouther Maatallah
,
Hanene Ferjani
,
Dhia Kaffel
,
Mohamed Montacer Kchir
Abstract
We aimed to determine the bone mineral status in patients with spondyloarthritis (SA), and to assess the impact of parameters associated with bone loss on bone mineral density (BMD). Seventy-five patients (62 men) with SA fulfilling the modified New York criteria were included in a cross-sectional study during one year. BMD was assessed in all patients using dual-energy X-ray absorptiometry. The patient’s average age was 36.8 years. Sixty-five patients (86.6%) had bone loss. The lumbar spine was the site most affected by osteoporosis (37%). Bone loss was significantly associated with low BMI, peripheral joint involvement, active disease (high ASDASESR and BASDAI), vitamin D insufficiency, elevated erythrocyte sedimentation rate (ESR) and c-reactive protein, as well as high BASRI, high BASMI, and with the use of csDMARDs or anti-TNF alpha therapy. The disease activity, biologic inflammation, low vitamin D level, peripheral joint involvement, and structural damage were the major factors that induce bone loss in SA patients. Multivariate analysis showed that only high ESR level (AOR 19.9, 95% CI) and peripheral arthritis (AOR 14.5, 95% IC) were independent risk factors of bone loss. Our study shows that bone loss was a multifactorial complication of SA.
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[12] Baek HJ, Kang SW, Lee YJ et al. Osteopenia in men with mild and severe ankylosing spondylitid. Rheumatol Int 2005;26:30-4.
[13] Kanis JA, Johnell O, Oden A et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:85-97.
[14] Donnelly S, Doyle DV, Rolfe J et al. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994;53:117-21.
[15] Jun JB, Joo KB, Her MY et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitid: a cross-sectional study. J rheumatol 2006;33:1637-41.
[16] Vosse D, Landewé R, van der Heijde D et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis. 2009;68:1839-42.
[17] Mitra D, Elvins DM, Speden DJ, Collins AJ. The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford, England) 2000;39:85–9.
[18] Boussoualima K, Amouzougana A, Pallot-Prades B et al. Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine. 2018 pii: S1297 319X(18)30046-0. doi: 10.1016/j.jbspin.2018.02.006.
[19] Kang KY, Kim IJ, Park SH et al. Associations between trabecular bone score and
vertebral fractures in patients with axial spondyloarthritis. Rheumatology (Oxford) 2018;57:1033-40.
[20] Hallstrom H, Wolk A, Glynn A et al. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int 2006;17:1055-64.
[21] Durmus B, Altay Z, Baysal O et al. Does vitamin D affect disease severity in patients with ankylosing spondylitis? Chib Med J 2012;125:2511-5.
[22] Lange U, Jung O, Teichmann J et al. Relationships between disease activity and serum levels of vitamin D metabolites and parathyroid hormone in ankylosing spondylitis. Osteoporos Int 2001;12:1031-5.
[23] Malterre L, Schaeverbeke T, Lequen L et al. Densité minérale et métabolisme osseux des spondyloarthropathies. Rev Med Int 2005;26:381-5.
[24] Mitra D, Elvins DM, Collins AJ. Testosterone and testosterone free index in mild ankylosing spondylitis: relationship with bone mineral density and vertebral fractures. J Rheumatol. 1999;26:2414-7.
[25] Onose G, Pereţianu D, Zaharescu J et al. Correlations between spondylarthropathic inflammatory troubles and gonadal (androgenic) troubles in men. Study on 30 cases with a new methodological analysis. Rom J Intern Med. 1995;33:93-111.
[26] Bronson WD, Walker SE, Hillman LS et al. Bone mineral density and biochemical markers of bone metabolism in ankylosing spondylitis. J Rheumatol 1998;25:929-35.
[27] Malterre L, Schaeverbeke T, Lequen L et al. Densité minérale et métabolisme osseux des spondyloarthropathies. Rev Med Int 2005;26:381-5.
[28] Cranney A, Horsely T, O’Donnell S et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 2007;158:1-235.
[29] Ghozlani I, Ghazi M, Nouijai A et al. Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 2009;44:772-6.
[30] Klingberg E, Geijer M, Gothlin J et al. Vertebral fractures in ankylosing spondylitis are associated with lower bone mineral density in both central and peripheral skeleton. J Rheumatol 2012;39:1987-95.
[31] Frank H, Meurer T, Hofbauer LC. Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism and osteoprotegrin serum levels in patients with ankylosing spondylitis. J Rheumatol 2004;31:2236-41.
[32] Aydin T, Karacan I, Demir SE et al. Bone loss in males with ankylosing spondylitis : its relation to sex hormone levels. Clin Endocrinol 2005;63:467-9.
[33] Wang DM, Zeng QY, Chen SB et al. Prevalence and risk factors of osteoporosis in patients with ankylosing spondylitis: a 5-year follow-up study of 504 cases. Clin Exp Rheumatol. 2015;33:465-70
[34] Cranney AB, McKendry RJ, Wells GA et al. The effect of low dose methotrexate on bone density. J Rheumatol 2001;28:2395-9.
[35] Wendling D, Claudepierre P, Lohse A et al. Utilisation thérapeutique des agents anti TNF-alpha au cours des spondyloarthropathies. Press Med 2003;32:1517-24.
[36] Allali F, Breban M, Porcher R et al. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor alpha. Ann Rheum Dis 2003;62:347-9.
[37] Siu S, Haraoui B, Bissonnette R et al. Meta-analysis of tumor necrosis factor inhibitors and glucocorticoids on bone density in rheumatoid arthritis and ankylosing spondylitis trials. Arthritis Care Res (Hoboken). 2015;67:754-64.
[38] Visvanathan S, van der Heijde D, Deodhar A et al. Effects of infliximab on markers of inflammation and bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:175-82.
[2] Haroon NN, Paterson JM, Li P, et al. Increasing proportion of female patients with ankylosing spondylitis: a population-based study of trends in the incidence and prevalence of AS. BMJ Open 2014;4:e006634.
[3] Ramírez J, Nieto-González JC, Curbelo Rodríguez R et al. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018;48:44-52.
[4] Pray C, Feroz NI, Haroon NN et al. Bone Mineral Density and Fracture Risk in Ankylosing Spondylitis: A Meta-Analysis. Calcif Tissue Int 2017;101:182–192.
[5] van der Weijden MA, Claushuis TA, Nazari T et al. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review. Clin Rheumatol 2012;31:1529–35.
[6] Davey-Ranasinghe N, Deodhar A. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2013;25:509–16.
[7] Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.
[8] El Maghraoui A, Chaouir S, Bezza A et al. Evaluation de la densité minérale osseuse au cours de la spondyloarthrite ankylosante par tomodensitométrie quantitative. Rev Mar Rhum 2003;15:129-33.
[9] Muntean L, Rajas-vargas M, Font P et al. Relative value of the lumbar spine and hip bone minearl density and bone turnover markers in men with ankylosing spondylitis. Clin Rheumatol 2011;30:691-5.
[10] Karberg K, Zochling J, Sieper J et al. Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 2005;32:1290-8.
[11] Van der Weijden MA, Van Denderen JC, Lems WF et al. low bone mineral density is related to male gender and decreased functional capacity in early spondyloarthropathies. Clin rheumatol 2011;30:497-503.
[12] Baek HJ, Kang SW, Lee YJ et al. Osteopenia in men with mild and severe ankylosing spondylitid. Rheumatol Int 2005;26:30-4.
[13] Kanis JA, Johnell O, Oden A et al. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19:85-97.
[14] Donnelly S, Doyle DV, Rolfe J et al. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994;53:117-21.
[15] Jun JB, Joo KB, Her MY et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitid: a cross-sectional study. J rheumatol 2006;33:1637-41.
[16] Vosse D, Landewé R, van der Heijde D et al. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis. 2009;68:1839-42.
[17] Mitra D, Elvins DM, Speden DJ, Collins AJ. The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford, England) 2000;39:85–9.
[18] Boussoualima K, Amouzougana A, Pallot-Prades B et al. Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine. 2018 pii: S1297 319X(18)30046-0. doi: 10.1016/j.jbspin.2018.02.006.
[19] Kang KY, Kim IJ, Park SH et al. Associations between trabecular bone score and
vertebral fractures in patients with axial spondyloarthritis. Rheumatology (Oxford) 2018;57:1033-40.
[20] Hallstrom H, Wolk A, Glynn A et al. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int 2006;17:1055-64.
[21] Durmus B, Altay Z, Baysal O et al. Does vitamin D affect disease severity in patients with ankylosing spondylitis? Chib Med J 2012;125:2511-5.
[22] Lange U, Jung O, Teichmann J et al. Relationships between disease activity and serum levels of vitamin D metabolites and parathyroid hormone in ankylosing spondylitis. Osteoporos Int 2001;12:1031-5.
[23] Malterre L, Schaeverbeke T, Lequen L et al. Densité minérale et métabolisme osseux des spondyloarthropathies. Rev Med Int 2005;26:381-5.
[24] Mitra D, Elvins DM, Collins AJ. Testosterone and testosterone free index in mild ankylosing spondylitis: relationship with bone mineral density and vertebral fractures. J Rheumatol. 1999;26:2414-7.
[25] Onose G, Pereţianu D, Zaharescu J et al. Correlations between spondylarthropathic inflammatory troubles and gonadal (androgenic) troubles in men. Study on 30 cases with a new methodological analysis. Rom J Intern Med. 1995;33:93-111.
[26] Bronson WD, Walker SE, Hillman LS et al. Bone mineral density and biochemical markers of bone metabolism in ankylosing spondylitis. J Rheumatol 1998;25:929-35.
[27] Malterre L, Schaeverbeke T, Lequen L et al. Densité minérale et métabolisme osseux des spondyloarthropathies. Rev Med Int 2005;26:381-5.
[28] Cranney A, Horsely T, O’Donnell S et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 2007;158:1-235.
[29] Ghozlani I, Ghazi M, Nouijai A et al. Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 2009;44:772-6.
[30] Klingberg E, Geijer M, Gothlin J et al. Vertebral fractures in ankylosing spondylitis are associated with lower bone mineral density in both central and peripheral skeleton. J Rheumatol 2012;39:1987-95.
[31] Frank H, Meurer T, Hofbauer LC. Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism and osteoprotegrin serum levels in patients with ankylosing spondylitis. J Rheumatol 2004;31:2236-41.
[32] Aydin T, Karacan I, Demir SE et al. Bone loss in males with ankylosing spondylitis : its relation to sex hormone levels. Clin Endocrinol 2005;63:467-9.
[33] Wang DM, Zeng QY, Chen SB et al. Prevalence and risk factors of osteoporosis in patients with ankylosing spondylitis: a 5-year follow-up study of 504 cases. Clin Exp Rheumatol. 2015;33:465-70
[34] Cranney AB, McKendry RJ, Wells GA et al. The effect of low dose methotrexate on bone density. J Rheumatol 2001;28:2395-9.
[35] Wendling D, Claudepierre P, Lohse A et al. Utilisation thérapeutique des agents anti TNF-alpha au cours des spondyloarthropathies. Press Med 2003;32:1517-24.
[36] Allali F, Breban M, Porcher R et al. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor alpha. Ann Rheum Dis 2003;62:347-9.
[37] Siu S, Haraoui B, Bissonnette R et al. Meta-analysis of tumor necrosis factor inhibitors and glucocorticoids on bone density in rheumatoid arthritis and ankylosing spondylitis trials. Arthritis Care Res (Hoboken). 2015;67:754-64.
[38] Visvanathan S, van der Heijde D, Deodhar A et al. Effects of infliximab on markers of inflammation and bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:175-82.
| Files | ||
| Issue | Vol 58, No 10 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v58i10.4910 | |
| Keywords | ||
| Bone density Bone loss Dual-energy X-ray absorptiometry (DXA) Osteoporosis Spondyloarthritis | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Hamdi W, Sellami M, Kasraoui A, Maatallah K, Ferjani H, Kaffel D, Kchir M. Risk Factors of Bone Loss in Spondyloarthritis. Acta Med Iran. 2020;58(10):486-493.
