Osteoporosis Management in Ankylosing Spondylitis

Hinze, Alicia M.; Louie, Grant H.

doi:10.1007/s40674-016-0055-6

Cited by 38 publications

(36 citation statements)

References 54 publications

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“…A recent reviews about osteoporosis management in AS discussed the use of bisphosphonates for males and females not planning on future pregnancies as the firstline therapy [13]. In our case, once bone resorption will be sufficiently upregulated, bisphosphonates will be required to manage osteoporosis.…”

Section: Discussionmentioning

confidence: 87%

Bone Histomorphometric Findings in Ankylosing Spondylitis: A Case Report

Kondo

Yamamoto

Watanabe

et al. 2018

Journal of Bone Biology and Osteoporosis

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There is minimal information on bone Histomorphometric characteristics in ankylosing spondylitis. We here report a case of a 36-year-old Japanese male that suffered from lumbago and could not gaze in the forward direction. Ultimately, a diagnosis of ankylosing spondylitis was made, and vertebroplasty was performed to correct the third lumbar spine. Histomorphometry of the iliac bone showed reduced bone volume parameters (bone volume, and trabecular thickness and width) than reference values. In addition, bone formation parameters (osteoid thickness and osteoblast surface per bone surface) and bone resorption parameters (eroded surface per bone surface and osteoclast number per bone surface) were also lower than reference values, indicating low bone turnover. By contrast, there was not a clear trend in bone resorption markers: bone- pecific alkaline phosphatase (17 U/l) was normal, TRACP-5b (136 mU/dl) was slightly lower, urinary N-terminal telopeptide (45.3 nmol BCE/mmol Cr) was normal, and deoxypyridinoline (9.1 nM/mM Cre) was higher than reference values. However, there was deficiency in 25-hydroxy vitamin D (25-OH-D; 14.4 ng/ml). This case highlights the rare possibility of performing bone histomorphometry, and indicates that a low bone volume and low bone turnover (in both bone formation and resorption) are characteristics of ankylosing spondylitis, although bone formation markers (bone-specific alkaline phosphatase) and bone mineral density are within the normal range. The possibility of a serum 25-OH-D deficient status in ankylosing spondylitis should be further considered.

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Section: Discussionmentioning

confidence: 87%

Bone Histomorphometric Findings in Ankylosing Spondylitis: A Case Report

Kondo

Yamamoto

Watanabe

et al. 2018

Journal of Bone Biology and Osteoporosis

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“…This phenomenon might be because the disease has a typical onset in the third and fourth decades, and many of these patients are younger than the usual cohort of patients at risk for osteoporosis. 29 Furthermore, up to now, specific recommendations for this group of patients regarding the right timing for osteoporosis screening are still lacking. 29 As mentioned earlier, DEXA also allows the quantification of regional fat mass and lean mass muscle.…”

Section: Dual-energy X-ray Absorptiometrymentioning

confidence: 99%

“…29 Furthermore, up to now, specific recommendations for this group of patients regarding the right timing for osteoporosis screening are still lacking. 29 As mentioned earlier, DEXA also allows the quantification of regional fat mass and lean mass muscle. It has also been used in this way in patients with inflammatory rheumatic diseases although with controversial results.…”

Section: Dual-energy X-ray Absorptiometrymentioning

confidence: 99%

“…Several methods have been proposed to compensate for this issue, such as the lateral lumbar DEXA or the modified Stoke Ankylosing Spondylitis Spine Score that quantifies the confounder effect of syndesmophytes in the cervical and lumbar spine. 29 In addition, HR-pQCT was promoted for the evaluation of BMD in this group of patients because it allows the exclusion of cortical bone and calcified ligaments from volumetric analyses. 29 High-resolution Peripheral Quantitative Computed Tomography HR-pQCT is a low radiation CT-based technique originally applied to investigate osteoporosis that was then further used for a deeper understanding of bone architecture.…”

Section: Dual-energy X-ray Absorptiometrymentioning

confidence: 99%

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Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation

Giraudo

Kainberger

Boesen

et al. 2020

Semin Musculoskelet Radiol

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Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.

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“…Available clinical practice guidelines suggest non-pharmacological (i.e. general exercise program) and pharmacological treatments (i.e., vitamin D, bisphosphonates) (6).…”

mentioning

confidence: 99%

The Value of Trabecular Bone Score in the Evaluation of Bone Quality in a Patient with Ankylosing Spondylitis

Zabihiyeganeh

Mirzaei

2017

Shafa Ortho J

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Patients with ankylosing spondylitis (AS) have an increased risk of developing osteoporosis, mainly caused by systemic inflammation and decreased mobility (1). For this reason, patients with AS demonstrate an increased risk of fractures, especially vertebral fractures, in comparison with the general population (2). However, measurements of areal bone mineral density (aBMD) are overestimated and unreliable in AS patients, because of the presence of osteo-proliferation and syndesmophytes. Significantly increased aBMD measures have been reported in patients with advanced AS (3). Consequently, the diagnosis of osteoporosis could be difficult in affected patients (1).Considering bone microarchitecture as another determinant of bone strength, and regarding less impact of osteoproliferation on bone microarchitecture, it could be a better predictor of bone strength in these patients (4). Trabecular bone score (TBS), a new noninvasive tool for the measurement of bone microarchitecture, could be used complementary to aBMD in the evaluation of bone quality in AS patients (5). In this letter, the authors discuss the value of TBS in the evaluation of bone quality in a patient with AS, and discuss its advantages over aBMD.A 47-year-old male with a 10-year history of inflammatory back pain was referred to the researcher's center. Acute phase reactants including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated and positive HLA-B27 was found. Other laboratory tests were within the normal range. Typical syndesmophytes were also observed in the spinal X-rays of the patient. The diagnosis of AS was made according to the assessment of spondylo arthritis international society (ASAS) criteria. Subsequently, the therapeutic approach was started with an anti-inflammatory dose of indomethacin. However, considering the patient's unresponsiveness, infliximab was added to his therapeutic regimen.Given the 10-year history of the disease, osteoporosis evaluation was indicated for the patient and aBMD was ordered. Considering the normal aBMD results of the patient (T-score > -1), according to the world health organization (WHO) criteria, no osteoporosis treatment was indicated for the patient. However, since the aBMD results was probably artifactually elevated by the presence of typical syndesmophytes, the patients was asked to recheck the aBMD results in another center, which was equipped to the TBS software. While the aBMD results of the second exam were the same as the first one, the patient's bone microarchitecture was classified as fully degraded (TBS ≤ 1.20). Consequently, zoledronic acid (Aclasta) was administered as the osteoporosis therapeutic agent.The case showed that regarding the presence of sindesmophytes, aBMD is not a reliable marker for the evaluation of bone quality in the affected patients (1). Considering the presence of typical syndesmophytes in the X-rays of the patient's vertebrae, the authors concluded that the aBMD is probably overestimated, and TBS could be more helpful in the evaluation...

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Osteoporosis Management in Ankylosing Spondylitis

Cited by 38 publications

References 54 publications

Bone Histomorphometric Findings in Ankylosing Spondylitis: A Case Report

Bone Histomorphometric Findings in Ankylosing Spondylitis: A Case Report

Quantitative Imaging in Inflammatory Arthritis: Between Tradition and Innovation

The Value of Trabecular Bone Score in the Evaluation of Bone Quality in a Patient with Ankylosing Spondylitis

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