Clinical studies on bone-related outcome and the effect of TNF-α blocking therapy in ankylosing spondylitis

Abstract

Both osteoproliferation (e.g. syndesmophytes and ankylosis of vertebrae) and excessive bone loss resulting in osteoporosis and vertebral fractures are frequently present in AS. Previous studies showed that BMD increases during TNF-α blocking therapy. Long-term follow-up in a large cohort of patients is needed to investigate whether TNF-α blockers can consolidate or stop spinal osteoproliferation and prevent vertebral fractures. Future studies should focus on the effect of these agents on bone-related outcome in AS patients with early vs. advanced disease.

Anti-tumor Necrosis Factor Therapy Increased Spine and Femoral Neck Bone Mineral Density of Patients with Active Ankylosing Spondylitis with Low Bone Mineral Density

“…Anti-TNF therapy having a positive effect on bone loss in RA was reported by many studies 16,17 . This effect was also reported in AS 8,9,10 . Durnez, et al 10 found that over an average followup of 6.5 years, the increase in BMD was …”

“…In Chopin, et al's research, sCTX was significantly decreased in patients with RA treated with infliximab, but the PINP was stable before and after treatment 18 . While in patients with AS treated with anti-TNF therapy, the sCTX also decreased as in RA, but the PINP significantly increased in our and other studies 8,9,10 . This suggests that when anti-TNF therapy was used in AS, the effect on bone formation was different compared with RA.…”

“…No longitudinal data were available about the effect of TNF-a blocking therapy on the occurrence of new vertebral fractures in AS 8 .…”

“…In patients receiving anti-tumor necrosis factor (anti-TNF) therapy, in parallel with significant improvement of symptoms and decrease of the inflammation, an increase in the lumbar spine and hip BMD has been reported 8,9,10,11 . However, the consequences of the present studies on this field seem to be conflicting 8 because they enrolled the whole AS group rather than only the patients with active AS with low BMD.…”

Soluble Tumor Necrosis Factor Alpha Receptor 1, Bone Resorption, and Bone Mineral Density in the Year Following Hip Fractures: The Baltimore Hip Studies

“…For clinical purposes, soluble TNFα‐R1 (sTNFα‐R1) with its long‐term bioavailability in stored serum is an optimal proxy of activated TNFα and a biomarker of systemic inflammation. Moreover, clinical data using TNF inhibitors in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (AS) have shown improvements in bone metabolite profiles and decreases in bone loss . Thus, we chose sTNFα‐R1 as a biomarker of inflammation for this study.…”