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Arends S, Wink F, Veneberg J, Bos R, van Roon E, van der Veer E, Maas F, Spoorenberg A. Bone mineral density improves during 2 years of treatment with bisphosphonates in patients with ankylosing spondylitis. Br J Clin Pharmacol 2020; 87:644-651. [PMID: 32530102 PMCID: PMC9328658 DOI: 10.1111/bcp.14431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/23/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022] Open
Abstract
Aims To evaluate whether 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements has an effect on lumbar spine and hip bone mineral density (BMD) in ankylosing spondylitis (AS) patients starting tumour necrosis factor‐α inhibitors or receiving conventional treatment. Secondly, to explore the development of radiographic vertebral fractures. Methods Patients from the Groningen Leeuwarden AS cohort receiving bisphosphonates based on clinical indication and available 2‐year follow‐up BMD measurements were included. BMD of lumbar spine (L1–L4) and hip (total proximal femur) were measured using dual‐energy X‐ray absorptiometry. Spinal radiographs (Th4–L4) were scored for vertebral fractures according to the Genant method. Results In the 20 included patients (median 52 years, 14 males), lumbar spine and hip BMD Z‐scores increased significantly; median from −1.5 (interquartile range [IQR] −2.2 to 0.4) to 0.1 (IQR −1.5 to 1.0); P < .001 and median from −1.0 (IQR −1.6 to −0.7) to −0.8 (IQR −1.2 to 0.0); P = .006 over 2 years, respectively. In patients also treated with tumour necrosis factor‐α inhibitors (n = 11), lumbar spine and hip BMD increased significantly (median 2‐year change +8.6% [IQR 2.4 to 19.6; P = .009] and +3.6% [IQR 0.7–9.0; P = .007]). In patients on conventional treatment (n = 9), lumbar spine BMD increased significantly (median 2‐year change +3.6%; IQR 0.7 to 9.0; P = .011) and no improvement was seen in hip BMD (median −0.6%; IQR −3.1 to 5.1; P = .61). Overall, younger AS males with limited spinal radiographic damage showed most improvement in lumbar spine BMD. Four mild radiographic vertebral fractures developed in 3 patients and 1 fracture increased from mild to moderate over 2 years in postmenopausal women and middle‐aged men. Conclusion This explorative observational cohort study in AS showed that 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements significantly improves lumbar spine BMD. Mild radiographic vertebral fractures still occurred.
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Affiliation(s)
- Suzanne Arends
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, RB, The Netherlands.,Rheumatology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands
| | - Freke Wink
- Rheumatology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands
| | - Joyce Veneberg
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, RB, The Netherlands.,Rheumatology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands.,Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands
| | - Reinhard Bos
- Rheumatology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands
| | - Eric van Roon
- Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands.,Pharmacotherapy, - Epidemiology and - Economics, Faculty Science & Engineering, University Groningen, Groningen, AB, The Netherlands
| | - Eveline van der Veer
- Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, RB, The Netherlands
| | - Fiona Maas
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, RB, The Netherlands
| | - Anneke Spoorenberg
- Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, RB, The Netherlands.,Rheumatology, Medical Center Leeuwarden, Leeuwarden, BR, The Netherlands
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Kang KY, Goo HY, Park SH, Hong YS. Trabecular bone score as an assessment tool to identify the risk of osteoporosis in axial spondyloarthritis: a case-control study. Rheumatology (Oxford) 2018; 57:462-469. [PMID: 29471485 DOI: 10.1093/rheumatology/kex377] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Indexed: 12/27/2022] Open
Abstract
Objectives To compare the trabecular bone score (TBS) between patients with axial spondyloarthritis (axSpA) and matched normal controls and identify risk factors associated with a low TBS. Methods TBS and BMD were assessed in the two groups (axSpA and control) using DXA. Osteoporosis risk factors and inflammatory markers were also assessed. Disease activity and radiographic progression in the sacroiliac joint and spine were evaluated in the axSpA group. Multivariate linear regression analysis was performed to identify risk factors associated with TBS. Results In the axSpA group, 248 subjects were enrolled; an equal number of age- and sex-matched subjects comprised the control group. The mean TBS was 1.43 (0.08) and 1.38 (0.12) in the control and axSpA groups, respectively (P < 0.001); BMD at the lumbar spine did not differ between the two groups. The TBS was negatively correlated with ESR and CRP levels in the axSpA group only (P < 0.001 and P = 0.007, respectively). Syndesmophytes in the axSpA group was associated with lower TBS (P < 0.001) but higher lumbar BMD (P = 0.021) vs controls. In the multivariate analyses, ESR, CRP and spinal radiographic progression were significantly associated with TBS. Conclusion TBS assessments revealed poor bone quality in patients with axSpA compared with the matched controls. In axSpA, systemic inflammatory markers were negatively correlated with TBS and spinal radiographic progression and inflammatory markers were independently correlated with low TBS. TBS may, therefore, be a useful clinical tool to identify the risk of osteoporosis in patients with axSpA.
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Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Hye Yeon Goo
- Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Yeon Sik Hong
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul.,Division of Rheumatology, Department of Internal Medicine, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
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Kang KY, Chung MK, Kim HN, Hong YS, Ju JH, Park SH. Severity of Sacroiliitis and Erythrocyte Sedimentation Rate are Associated with a Low Trabecular Bone Score in Young Male Patients with Ankylosing Spondylitis. J Rheumatol 2018; 45:349-356. [DOI: 10.3899/jrheum.170079] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/25/2022]
Abstract
Objective.To examine factors related to a low trabecular bone score (TBS) and the association between TBS and vertebral fractures in patients with ankylosing spondylitis (AS).Methods.One hundred patients (all male, aged < 50 yrs) who fulfilled the modified New York criteria for the classification of AS were enrolled. The TBS and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry. Clinical variables, inflammatory markers, and the presence of vertebral fractures were also assessed. Sacroiliitis grade and spinal structural damage were measured using the modified New York criteria and the Stoke Ankylosing Spondylitis Spine Score (SASSS).Results.The mean TBS was 1.38 ± 0.13. The TBS showed a positive correlation with BMD at the lumbar spine, femoral neck, and total hip. TBS negatively correlated with SASSS, whereas BMD at the lumbar spine showed a positive correlation. A significant decrease in TBS values was observed in patients with spinal structural damage (p = 0.001). Univariate analysis identified disease duration, erythrocyte sedimentation rate (ESR), sacroiliitis grade, and SASSS as being associated with TBS. Multivariate analysis identified ESR and sacroiliitis grade as being independently associated with TBS (p = 0.006 and p < 0.001, respectively). Ten patients had morphometric vertebral fractures. The mean TBS was lower in patients with vertebral fractures than in age-matched patients without fractures (p = 0.028). Lower TBS predicted vertebral fractures (area under curve = 0.733, cutoff = 1.311).Conclusion.The TBS in young male patients with AS is associated with the ESR and severity of sacroiliitis. The TBS may be useful as a tool for assessing osteoporosis in AS.
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