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Nakamura A, Towheed T. Pathogenesis, assessment, and management of bone loss in axial spondyloarthritis. Semin Arthritis Rheum 2024; 64:152345. [PMID: 38103486 DOI: 10.1016/j.semarthrit.2023.152345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Axial spondyloarthritis (axSpA) presents a complex scenario where both new bone formation in entheseal tissues and significant trabecular bone loss coexist, emphasizing the intricate nature of bone dynamics in this context. METHODS A search of the literature was conducted to compose a narrative review exploring the pathogenesis, possible assessment methods, and potential management options for axSpA. RESULTS While chronic systemic and local inflammation contribute to bone loss, the mechanisms behind axSpA-associated bone loss exhibit distinct characteristics influenced by factors like mechanical stress and the gut microbiome. These factors directly or indirectly stimulate osteoclast differentiation and activation through the RANK-RANKL axis, while simultaneously impeding osteoblast differentiation via negative regulation of bone anabolic pathways, including the Wnt signaling pathway. This disruption in the balance between bone-resorbing osteoclasts and bone-forming osteoblasts contributes to overall bone loss in axSpA. Early evaluation at diagnosis is prudent for detecting bone changes. While traditional dual x-ray absorptiometry (DXA) has limitations due to potential overestimation from spinal new bone formation, alternative methods like trabecular bone score (TBS), quantitative CT (QCT), and quantitative ultrasound (QUS) show promise. However, their integration into routine clinical practice remains limited. In addition to approved anti-inflammatory drugs, lifestyle adjustments like regular exercise play a key role in preserving bone health. Tailoring interventions based on individual risk profiles holds potential for mitigating bone loss progression. CONCLUSION Recognizing the pivotal role of bone loss in axSpA underscores the importance of integrating regular assessments and effective management strategies into clinical practice. Given the multifaceted contributors to bone loss in axSpA, a multidisciplinary approach is essential.
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Affiliation(s)
- Akihiro Nakamura
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, School of Medicine, Queen's University, Ontario, Canada; Kingston Health Science Centre, Kingston, Ontario, Canada.
| | - Tanveer Towheed
- Department of Medicine, Division of Rheumatology, Queen's University, Kingston, Ontario, Canada; Translational Institute of Medicine, School of Medicine, Queen's University, Ontario, Canada; Kingston Health Science Centre, Kingston, Ontario, Canada.
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Chen M, Li W, Li L, Chai Y, Yang Y, Pu X. Ankylosing spondylitis disease activity and serum vitamin D levels: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31764. [PMID: 36401455 PMCID: PMC9678609 DOI: 10.1097/md.0000000000031764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To prove that serum vitamin D (VD) levels are strongly associated with ankylosing spondylitis (AS) disease activity, the association between serum VD levels and key monitoring indicators of AS disease activity has been analyzed, such as the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). METHODS Studies published in PubMed, Cochrane Library, EMBASE, and China National Knowledge Infrastructure by August 30, 2022 were searched, and 6 studies finally met the selection criteria. Serum 25-hydroxyvitamin D (25(OH)D), ESR, CRP levels, and correlation coefficients between serum VD and BASDAI, ESR, CRP in AS, and control in these studies were extracted for the meta-analysis. RESULTS When compared to controls, patients with AS had considerably lower blood 25(OH)D levels (MD = -7.53 ng/mL, 95% CI, -9.78 to -5.28, P < .001) and significantly higher ESR and CRP levels (ESR: MD = 11.75 mm/h, 95% CI, 4.20 to 19.31, P = .002; CRP: MD = 15.36 mg/L, 95% CI, 4.95 to 25.77, P = .004). Additionally, a negative correlation was discovered between serum VD levels and BASDAI, ESR, and CRP (Fisher' Z = -0.34, -0.38, -0.35, respectively). CONCLUSION The findings of our meta-analysis demonstrated a negative correlation between serum VD levels and the main monitoring indices of disease activity in patients with AS and verified that the differences in the continent and ethnicity may be one of the major contributors to this finding.
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Affiliation(s)
- Menglu Chen
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Wen Li
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Lailai Li
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Yihui Chai
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Yuqi Yang
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
| | - Xiang Pu
- Guizhou University of Traditional Chinese Medicine, Guiyang City, Guizhou Province, China
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Eun IS, Park SH, Goh TS, Son SM, Kim DS, Lee JS. Effect of bisphosphonates on ankylosing spondylitis: A meta-analysis. J Clin Neurosci 2021; 92:153-158. [PMID: 34509243 DOI: 10.1016/j.jocn.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2021] [Accepted: 08/15/2021] [Indexed: 12/01/2022]
Abstract
This study aimed to compare outcomes between ankylosing spondylitis (AS) treated with and without bisphosphonate (BP; non-BP) through a meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of AS, including patient age, disease duration, disease activity, and bone mineral density (BMD), published between January 2000 and March 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Six comparative studies were identified. No significant differences were found between the BP and non-BP groups in terms of demographic characteristics, disease activity, and BMD, except for follow-up erythrocyte sedimentation rate (ESR). The follow-up ESR was higher in the BP than in the non-BP group. A literature review identified six comparative studies reporting the outcomes of BP and non-BP treatments for AS. Despite the heterogeneity, a limited number of meta-analyses reported that BP treatment was not clearly better than non-BP treatment. Hence, further large-scale multicenter studies are required to validate our results.
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Affiliation(s)
- Il-Soo Eun
- Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Republic of Korea
| | - Shi Hwan Park
- Department of Orthopaedic Surgery, Gupo Sungshim Hospital, Busan, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Seung Min Son
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Suk Kim
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
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Tang HY, Li YZ, Tang ZC, Jiang QW, Zhao Y. Efficacy of alendronate for the treatment of ankylosing spondylitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21089. [PMID: 32791682 PMCID: PMC7386951 DOI: 10.1097/md.0000000000021089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a very tricky orthopedic disorder. If such condition cannot be managed fairly well, it may significantly affect quality of life and even leads to disability among such population. A variety of studies have reported that alendronate is utilized for the treatment of AS. However, their results are still contrary, and no systematic review has addressed on this topic. Thus, this study will systematically assess the efficacy and safety of alendronate for the treatment of patients with AS. METHODS A comprehensive literature search will be performed from the below electronic databases from their commencement to the January 31, 2020 without language and publication status limitations: PubMed, Embase, Cochrane Library, Web of Science, Allied and Complementary Medicine Database, WANGFANG, and China National Knowledge Infrastructure. Only randomized controlled trials focusing on the alendronate for the treatment of patients with AS will be considered for inclusion in this study. Two authors will independently select all identified records, extract essential data from all included studies, and appraise study quality for each eligible trial using Cochrane risk of bias. If any differences occur, another experienced author will be invited to solve them by discussion and a consensus decision will be made. We will implement RevMan 5.3 software to analyze the extracted data. RESULTS This study will summarize high-quality randomized controlled trials to assess the efficacy and safety of alendronate for the treatment of patients with AS through primary outcome of bone densitometry; and secondary outcomes of pain intensity, quality of life, disease activity, functional status, and adverse events. CONCLUSION This study will provide evidence to help determine whether alendronate is an effective and safe management for patient with AS or not. STUDY REGISTRATION INPLASY202040153.
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Affiliation(s)
| | - Yu-zhi Li
- Department of Urology, First Affiliated Hospital of Jiamusi University
| | - Zhao-chen Tang
- School of Clinical Medicine, Jiamusi University, Jiamusi
| | - Quan-wei Jiang
- Department of Anesthesiology, Benxi Central Hospital of China Medical University, Benxi
| | - Yu Zhao
- Department of Orthopedics, Huludao Central Hospital, Huludao, China
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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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Lin X, Zhang HQ, Shou LH, Shen XL, Zhang ZX. Efficacy of vitamin D plus calcium with/without alendronate on bone metabolism in immunologic thrombocytopenic purpura patients with steroid treatment: Nine-month results of a randomized, double-blinded, controlled trial. Exp Ther Med 2019; 18:1391-1398. [PMID: 31363377 DOI: 10.3892/etm.2019.7694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/31/2018] [Indexed: 11/06/2022] Open
Abstract
Bone loss is a prominent complication in immunologic thrombocytopenic purpura (ITP) patients with steroid treatment. Anti-osteoporotic medications are applied as a therapeutic strategy to prevent bone deterioration in ITP patients. However, the skeletal protective effect of alendronate (ALN) in ITP patients has been rarely reported. The present study was performed to determine whether ALN reduces bone loss in ITP patients. A total of 40 ITP patients with steroid treatment were randomized into a placebo group [n=20; caltrate D (CalD)] and an ALN (10 mg/day) + CalD group (n=20). The patients received CalD or CalD + ALN treatment for 9 months. The primary outcomes were bone mineral density (BMD) in the lumbar vertebrae (L1-L4), femoral neck and total hip, as well as bone metabolism markers. The results indicated that the BMD of the lumbar vertebrae (L1-L4), femoral neck and total hip was significantly increased after ALN + CalD treatment for at 6 and 9 months compared with the baseline. Compared with CalD treatment alone, CalD combined with ALN significantly elevated the BMD at the three skeletal sites at 9 months. Compared with the baseline levels or CalD treatment alone, ALN together with CalD treatment markedly reduced urinary Ca excretion and the serum levels of the bone resorption markers tartrate resistant acid phosphatase 5b and C-terminal telopeptides of type 1 collagen, at 9 months. In conclusion, treatment with ALN together with CalD significantly elevated the BMD at three skeletal sites, and inhibited urinary Ca excretion and the activity of bone resorption markers in patients with ITP.
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Affiliation(s)
- Xia Lin
- Department of Hematology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Hui-Qi Zhang
- Department of Hematology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Li-Hong Shou
- Department of Hematology, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China
| | - Xiang-Li Shen
- Department of Hematology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang 313000, P.R. China
| | - Zong-Xin Zhang
- Clinical Laboratory, Huzhou Central Hospital, Huzhou, Zhejiang 313003, P.R. China
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McKenna SP. It is time for an organised, scientific approach to the application of patient-reported outcome measures in clinical studies and trials. Clin Rheumatol 2018; 38:611-615. [PMID: 30564944 DOI: 10.1007/s10067-018-04403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
Too often, clinicians and researchers assume that patient-reported outcome measures (PROMs) are simply designed, can be changed to suit specific circumstances and should be freely available for use without seeking permission. If a version is not easily available, they believe they can produce a new translation without relevant experience or expertise. Copyright issues are inconvenient and commonly ignored, despite some journals requesting confirmation from authors that permission had been granted for use of copyrighted materials. When informed that authors of an article did not have such permission, the response from an editor was that nothing could be done as he had to rely on the word of the authors.In fact, high quality PROMs are carefully designed, developed for new cultures by means of proven standardised methodologies, carefully re-validated in the new culture and then administered by a responsible organisation to ensure that they are used appropriately in studies. If such care has not been taken, questions should be raised about the quality of the measure and the information it generates.Several problems have arisen with the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). This is probably because it is recognised as the most appropriate measure of quality of life for people with Ankylosing Spondylitis and has been widely used in international clinical trials and studies. Fifty-seven official language adaptations of the questionnaire have been produced. Unfortunately, as a result of unauthorised adaptation and use, questions are raised about the validity of several publications that have used the ASQoL.
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Affiliation(s)
- Stephen P McKenna
- Galen Research, Manchester, UK.
- School of Health Sciences, University of Manchester, Manchester, UK.
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