Clinical Risk Factors for the Presence and Development of Vertebral Fractures in Patients With Ankylosing Spondylitis

Maas, F.; Spoorenberg, A.; Slik, Boukje P. G. van der; Veer, Eveline van der; Brouwer, Elisabeth; Bootsma, Hendrika; Bos, Reinhard; Wink, F.; Arends, Suzanne

doi:10.1002/acr.22980

Cited by 40 publications

(41 citation statements)

References 43 publications

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“…In our study, prevalent and incident VFs were observed in patients receiving NSAIDs and TNF blockers, even if it is impossible to definitively conclude because of the low number of incidental events. Unlike other studies,23 24 we did not identify any risk factors of VF related to SpA disease but the small number of events, making impossible any definitive interpretation. These discrepancies can also be explained by the different methods used for vertebral fracture diagnosis (semiautomated, semiquantitative, qualitative, etc).…”

Section: Discussioncontrasting

confidence: 83%

“…Both the prevalence and the incidence of VFs reported in our study are lower than that reported in previous studies. Prevalence of VFs ranges from 4% to 42% 22–28. Data from large databases assessed the relationship between SpA and clinical VFs 29 30.…”

Section: Discussionmentioning

confidence: 99%

“…In 176 patients (79% men, aged 48.6±13.1 years), with a mean disease duration of 22 years, the prevalence of VFs using a semiautomated software was 32.4%, 82% of the fractures were at the thoracic spine and 65% of them were mild. In a large prospective cohort of 292 patients (mean age of 42.8 years, 70% men) with ankylosing spondylitis (mean time since the diagnosis of 6 years and a mean duration of symptoms of 16 years), 15 (6%) developed new VFs over 2 years 24. Most fractures were mild and located at the midthoracic and thoracolumbar regions of the spine 24.…”

Section: Discussionmentioning

confidence: 99%

“…In a large prospective cohort of 292 patients (mean age of 42.8 years, 70% men) with ankylosing spondylitis (mean time since the diagnosis of 6 years and a mean duration of symptoms of 16 years), 15 (6%) developed new VFs over 2 years 24. Most fractures were mild and located at the midthoracic and thoracolumbar regions of the spine 24. In this study, VFs were frequently observed in older patients, with advanced disease, low hip BMD and less healthy life.…”

Section: Discussionmentioning

confidence: 99%

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Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

Sahuguet

Fechtenbaum²,

Moltó

et al. 2018

Ann Rheum Dis

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ObjectivesAn increased risk of vertebral fractures (VFs) has been reported in spondyloarthritis (SpA). Our hypothesis is that the prevalence of VFs is lower than reported in previous studies, especially in early SpA. This study aimed at assessing the incidence of radiographical VFs over 5 years in early axial SpA.MethodsThe DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort, which included patients with inflammatory back pain highly suggestive of axial SpA, is the basis of this study. All radiographs of the DESIR cohort had been assessed at a central facility, by one investigator specialised in the field of the diagnosis of VFs according to Genant’s method. We assessed the prevalence and incidence of VFs and vertebral deformities at baseline and over 5 years.ResultsFive-year X-rays were available for 432 patients (mean age 34.3±8.7 years, 53% women). Diagnosis of VF was doubtful and needed adjudication for 19 patients (4.4%). 13 patients had prevalent VFs (3.0%) which were located at the thoracic spine (12 were grade 1). At 5 years, five patients had an incident VF (1.15%); seven vertebrae were fractured, mostly located at the thoracic spine (n=6/7), and of grade 1 (n=6/7).ConclusionIn the DESIR cohort, a population of early SpA, we found a low prevalence and incidence of VFs (3.0% and 1.15 %), respectively. This confirms our hypothesis that the actual prevalence and incidence of VFvertebral fracture in SpA is lower than that reported in the previous studies.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

Sahuguet

Fechtenbaum²,

Moltó

et al. 2018

Ann Rheum Dis

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“…A 2-year follow-up randomized controlled study showed that continuous non-steroidal anti-in ammatory drug treatment could reduce the progression of spine imaging in patients with AS [22]. Previous studies also reported that continuous NSAID treatment could reduce the risk of fracture in patients with AS [23].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Radiological Hip Joint Involvement in Patients with Ankylosing Spondylitis

Liu¹,

Song²,

Man³

et al. 2020

Preprint

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Background: The associated factors for hip involvement in patients with ankylosing spondylitis (AS) are poorly known. This study was to analyze the clinical data of patients with AS and to explore the potential associated factors of AS-related radiological hip joint.Methods: This was a cross-sectional study of patients diagnosed with AS and treated at the Beijing Jishuitan Hospital between 01/2013 and 12/2019. A BASRI-hip score ≥ 2 was defined as radiological hip joint involvement. Univariable and multivariable logistic regression analyses were performed to analyze the factors associated with radiological hip joint involvement.Results: A total of 350 AS patients were included. Patients with radiological hip joint involvement (BASRI-hip ≥2) accounted for 50.6% (177/350). The proportion of men was 83.7% (293/350). The mean age was 35.0±12.7 years old. The mean duration of the disease was 10.8±8.6 years. The HLA-B27 positive rate was 90.9% (318/350). The multivariable analysis showed that the juvenile onset (OR=4.955, 95%CI: 2.464-9.961, P<0.001), bone mass lower than peers (OR=2.862, 95%CI: 1.593-5.142, P<0.001), BMI <18.5 kg/m2 (OR=2.832, 95%CI: 1.321-6.069, P=0.007), BASFI (OR=1.278, 95%CI: 1.069-1.527, P=0.007), and continuous NSAIDs treatment (OR=0.400, 95%CI: 0.200-0.799, P=0.009) were independently associated with radiological hip joint involvement in patients with AS.Conclusion: AS with radiological hip joint involvement had worse body function and lower bone density. The associated factors with radiological hip joint involvement in AS patients included juvenile-onset, thin body size. The prognosis of patients with AS who received continuous NSAIDs drug treatment might be improved.

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Long-Term Treatment With TNF-Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis

Beek

Rusman

Weijden

et al. 2019

Journal of Bone and Mineral Research

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The aim of this cohort study was to evaluate the long-term effects of TNF inhibitors (TNFis) on BMD and the incidence of vertebral fractures (VFxs) in patients with ankylosing spondylitis (AS). Consecutive patients with active AS with TNFi treatment duration up to 4 years with available DXA scans and spine X-rays were included. BMD (classified according to the WHO criteria for osteoporosis) of the hip and lumbar spine, the VFx (classified as a Genant score !1/!20% height loss), and radiological progression (modified stoke ankylosing spondylitis spinal score [mSASSS]) scores were obtained at baseline and at 4 years of TNFi treatment. Overall, 135 AS patients were included. At baseline, 40.1% of patients had low BMD of the hip and 40.2% of the lumbar spine. This decreased to 38.1% (p ¼ 0.03) with low hip BMD and 25.3% (p < 0.001) of the lumbar spine BMD after 4 years of TNFi treatment. VFxs were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score !2, was found at baseline in 3 out of 14 VFx (21.4%) patients, which increased to 7 out of 27 VFx (25.9%) patients after 4 years. All disease activity parameters-the ankylosing spondylitis disease activity scale, the C-reactive protein, the erythrocyte sedimentation rate, and the bath ankylosing spondylitis disease activity index-decreased significantly (p < 0.001). The mean radiological progression (n ¼ 80) increased significantly from a median mSASSS of 4.0 (1.5 to 16.0) at baseline to 6.5 (2.1 to 22.9) after 4 years of TNFi treatment (p < 0.001). Despite the improvement in BMD and the decrease in disease activity, we still found new VFxs, an increase in severity in the number and grade of VFxs, and radiographic progression during 4 years of treatment with TNFis in AS patients with long disease duration.

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Clinical Risk Factors for the Presence and Development of Vertebral Fractures in Patients With Ankylosing Spondylitis

Cited by 40 publications

References 43 publications

Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort

Factors Associated with Radiological Hip Joint Involvement in Patients with Ankylosing Spondylitis

Long-Term Treatment With TNF-Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis

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