Abstract
Summary
We demonstrated that vertebral fractures (VF) are commonly found in early SpA. Patients with VF had lower lumbar BMD than patients without VF. VF remained frequently ‘unrecognized’ and untreated. VF have been associated with more back pain, reduced Qol, and increased risk of future fractures which stresses the importance of recognition also in early stage SpA.
Introduction
VF are a common complication of long-standing ankylosing spondylitis (AS). However, data of VF in early AS patients and in other spondylarthropathies (SpA) are scarce. Therefore we examined the prevalence of VF in early SpA patients and investigated the associations between VF and demographic and disease-related variables.
Methods
SpA patients were included consecutively and radiographs of the spine were made. VF were assessed according to the method of Genant et al.: fractures were defined as reduction of ≥20% of the vertebrae. Descriptive statistics, t-tests and logistic regression analyses were used to study the relationship between VF and demographic and disease-related variables, radiographic damage and BMD.
Results
A total of 113 early SpA patients were included with a disease duration of 7 months, a mean age of 37 years. Seventeen patients (15%) had at least one VF. Fourteen patients had one VF, three patients had two VF. Most VF were located at Th6–Th8. In patients with VF, bone mineral density (BMD) of lumbar spine was lower than BMD of patients without VF (t-test: p = 0.043). Axial Psoriatic Arthritis (PsA) was significantly associated with a higher risk for VF (odds ratio [OR]: 4.62, 95% confidence interval [CI] 1.15–18.58, p = 0.031). No significant associations were found with disease activity variables nor with radiographic severity.
Conclusion
In a group of 113 early, young SpA patients, 15% already had at least one VF. Most VF were asymptomatic, undetected by routine diagnostic procedures and located at the mid-thoracic spine. The VF were associated with low BMD of the lumbar spine and with axial PsA.
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References
Bessant R, Keat A (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29:1511–1519
El Maghraoui A, Borderie D, Cherruau B, Edouard R, Dougados M, Roux C (1999) Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 26:2205–2209
Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford) 39:85–89
Will R, Palmer R, Bhalla AK, Ring F, Calin A (1989) Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet 2:1483–1485
Karberg K, Zochling J, Sieper J, Felsenberg D, Braun J (2005) Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 32:1290–1298
Altenbernd J, Bitu S, Lemburg S, Peters S, Seybold D, Meindl R et al (2009) Vertebral fractures in patients with ankylosing spondylitis: a retrospective analysis of 66 patients. Rofo 181:45–53
Vosse D, Feldtkeller E, Erlendsson J, Geusens P, van der Linden S (2004) Clinical vertebral fractures in patients with ankylosing spondylitis. J Rheumatol 31:1981–85
Cooper C, Carbone L, Michet CJ, Atkinson EJ, O'Fallon WM, Melton LJ III (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21:1877–1882
van der Weijden MA, van Denderen JC, Lems WF, Heymans MW, Dijkmans BA, van der Horst-Bruinsma IE (2011) Low bone mineral density is related to male gender and decreased functional capacity in early spondylarthropathies. Clin Rheumatol 30:497–503
Briggs AM, Greig AM, Wark JD (2007) The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int 18:575–584
Schuit SC, van der KM, Weel AE, de Laet CE, Burger H, Seeman E et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34:195–202
Lems WF (2007) Clinical relevance of vertebral fractures. Ann Rheum Dis 66:2–4
Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237:2613–2614
Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291
Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285
Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21:1694–1698
Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL (2005) Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis 64:127–129
WHO Study Group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129
Genant HK, Wu CY, van KC, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–11348
El Maghraoui A (2004) Osteoporosis and ankylosing spondylitis. Joint Bone Spine 71:291–295
Ghozlani I, Ghazi M, Nouijai A, Mounach A, Rezqi A, Achemlal L et al (2009) Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 44:772–776
Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53:117–121
Lee W, Reveille JD, Davis JC Jr, Learch TJ, Ward MM, Weisman MH (2007) Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis 66:633–638
Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157
Montala N, Juanola X, Collantes E, Munoz-Gomariz E, Gonzalez C, Gratacos J et al (2011) Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis. J Rheumatol 38:893–897
Vosse D, Landewe R, van der Heijde D, van der Linden S, van Staa TP, Geusens P (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 68:1839–1842
Harrison BJ, Hutchinson CE, Adams J, Bruce IN, Herrick AL (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61:1007–1011
Borman P, Babaoglu S, Gur G, Bingol S, Bodur H (2008) Bone mineral density and bone turnover in patients with psoriatic arthritis. Clin Rheumatol 27:443–447
Frediani B, Allegri A, Falsetti P, Storri L, Bisogno S, Baldi F et al (2001) Bone mineral density in patients with psoriatic arthritis. J Rheumatol 28:138–143
Dheda K, Cassim B, Patel N, Mody GM (2004) A comparison of bone mineral density in Indians with psoriatic polyarthritis and healthy Indian volunteers. Clin Rheumatol 23:89
Grisar J, Bernecker PM, Aringer M, Redlich K, Sedlak M, Wolozcszuk W et al (2002) Ankylosing spondylitis, psoriatic arthritis, and reactive arthritis show increased bone resorption, but differ with regard to bone formation. J Rheumatol 29:1430–1436
Nolla JM, Fiter J, Rozadilla A, Gomez-Vaquero C, Mateo L, Rodriguez-Moreno J et al (1999) Bone mineral density in patients with peripheral psoriatic arthritis. Rev Rhum Engl Ed 66:457–461
Grigoryan M, Guermazi A, Roemer FW, Delmas PD, Genant HK (2003) Recognizing and reporting osteoporotic vertebral fractures. Eur Spine J 12(Suppl 2):S104–S112
Papaioannou A, Kennedy CC, Ioannidis G, Gao Y, Sawka AM, Goltzman D et al (2008) The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 19:581–587
Geusens P, Vosse D, van der Linden S (2007) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19:335–339
Lentle BC, Brown JP, Khan A, Leslie WD, Levesque J, Lyons DJ et al (2007) Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures. Can Assoc Radiol J 58:27–36
Naves M, az-Lopez JB, Gomez C, Rodriguez-Rebollar A, Rodriguez-Garcia M, Cannata-Andia JB (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–5524
Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828
Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68
Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
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van der Weijden, M.A.C., van der Horst-Bruinsma, I.E., van Denderen, J.C. et al. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int 23, 1683–1690 (2012). https://doi.org/10.1007/s00198-011-1766-z
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DOI: https://doi.org/10.1007/s00198-011-1766-z