High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Decreased bone mineral density (BMD) is a common complication of AS, with a prevalence range of 19 to 62 %. Many studies have shown decreased BMD in AS with long disease duration, but only a few studies investigated BMD in early AS. The prevalence of decreased BMD in early disease stages of AS has not yet been clearly described, and for that reason, we reviewed the literature which describes the prevalence of decreased BMD in AS patients with a short disease duration (<10 years). In this review, we included articles which used the modified New York criteria for the diagnosis of AS, included patients with a disease duration of less than 10 years, and used the WHO criteria for osteopenia and osteoporosis. Decreased BMD was defined as a T score < −1.0, including both osteopenia and osteoporosis. For this review, only articles that acquired BMD data of lumbar spine and femoral neck by DXA were used. The literature search provided us 35 articles of which 7 matched all our criteria, and they will be further outlined in this review. The overall prevalence of decreased BMD of the articles reviewed is 54 % (n = 229/424) for lumbar spine and 51 % (n = 224/443) for femoral neck. The prevalence of osteopenia vs. osteoporosis for lumbar spine is 39 vs. 16 % and for femoral neck, 38 vs. 13 %. This review showed a high total prevalence of 51–54 % decreased BMD and 13–16 % osteoporosis in AS with a short disease duration. This high prevalence was not to be expected in a relatively young and predominantly male population. Further research is needed to determine the clinical relevance of this low BMD by investigating the relation between low BMD and vertebral and nonvertebral fractures at this early stage in AS.

The Pilates method in the rehabilitation of musculoskeletal disorders: a systematic review

“…Ankylosing Spondylitis (AS) is a chronic disease characterized by rheumatic in lammation (37) of the axial skeleton and sacroiliac joints (38), which affects men more than women (37). Its main clinical manifestations include back pain and stiffness for more than three months, which improves with exercise, but is not relieved by rest (37).…”

“…Its main clinical manifestations include back pain and stiffness for more than three months, which improves with exercise, but is not relieved by rest (37). Involvement of peripheral joints is reported in approximately one third of patients, most often in the hip, shoulder and knee (38).…”

Evolution of traumatic spinal cord injury in patients with ankylosing spondylitis, in a Romanian rehabilitation clinic

“…5,6 Decreased bone mineral density-with a prevalence between 19 and 62% 7,8 -parallels the long disease evolution; literature pointed unexpected high prevalence of osteoporosis (13-16%) even within 10 years of onset of AS, at relatively young males. 7 The intimate/molecular basis of the underlying physiopathological process is the genetic, immune-reactive stigmatization of the affected patients, connected to the presence of the HLA B27 antigen, especially to its (class I) defective allelic subtype. 9 The axial forms of AS have the strongest association with the presence of the HLA B27 antigen, thus sustaining a genetic topographic determination.…”

New aspects of spondyloarthritis pathogenesis. Part III – arthritis, pathological bone remodeling

“…sacroiliac joints in AS or small joints of the hands in PsA. Common complications of AS are osteopenia, osteoporosis, and vertebral fractures, the latter often undiagnosed [5][6][7]. Low bone mineral density and osteoporosis can be detectable already within the first decade of the disease (in 51-54% and 13-16% of patients, respectively) [5].…”

“…Common complications of AS are osteopenia, osteoporosis, and vertebral fractures, the latter often undiagnosed [5][6][7]. Low bone mineral density and osteoporosis can be detectable already within the first decade of the disease (in 51-54% and 13-16% of patients, respectively) [5]. Recent findings suggest a very early manifestation of a significant loss of bone mass in the lumbar segment of the spine in patients with axial SpA -as soon as in the first year of the disease [8].…”