Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

Kuru, Omer; SARICA, Nebahat; Ulusoy, Hasan; ARSLAN, Şule; BİLGİCİ, Ayhan; Erkorkmaz, Ünal

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

Hasan ULUSOY, (Gaziosmanpaşa Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Tokat, Türkiye)

Ayhan BİLGİCİ, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Samsun, Türkiye)

Ömer KURU, (Ondokuz Mayıs Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Samsun, Türkiye)

Nebahat SARICA, (Gaziosmanpaşa Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Tokat, Türkiye)

Şule ARSLAN, (Gaziosmanpaşa Üniversitesi, Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Tokat, Türkiye)

Ünal ERKORKMAZ (Gaziosmanpaşa Üniversitesi, Tıp Fakültesi, Biyoistatistik Anabilim Dalı, Tokat, Türkiye)

Turkish Journal of Rheumatology(.)Archives of Rheumatology

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Yıl: 2010 Cilt: 25 Sayı: 1 Sayfa Aralığı: 24 - 28 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis

Öz:

Amaç: Bu retrospektif çalışma ankilozan spondilitli hastalarda (AS) lomber vertebra ve femur boynunda kemik mineral yoğunluğunu (KMY) belirlemek, KMY ile klinik, radyolojik ve laboratuvar parametreler arasındaki ilişkiyi değerlendirmek amacıyla planlanmıştır.Yöntem ve Gereçler: Çalışma grubu, ortalama hastalık süresi 11.9±6.1 yıl olan 28 AS hastasından oluşmuştur. Klinik ve demografik değişkenlere ilave olarak dual energy X-ray absorbtiometry (DEXA) ile belirlenmiş lomber bölge ve femur boyun KMY değerleri kaydedildi. Lomber spinal skor (LSS) ve sakroiliyak skor (SIS) standard radyografiler kullanılarak hesaplandı. Eritrosit sedimentasyon hızı (ESH) ve C-reaktif protein düzeyleri laboratuvar parametreler olarak belirlendi.Bulgular: Osteoporoz ve osteopeni sıklığı sırasıyla lomber bölgede %7.1 ve %25, femur boynunda %14.2 ve %17.8 olarak bulundu. LSS lomber KMY ile pozitif korelasyon gösterirken (r=0.70, p<0.001), femur boyun KMY ile korelasyon göstermemiştir (r=-0.11, p=0.55). SIS ile femur boyun KMY arasında negatif korelasyon bulunurken (r=-0.79, p<0.001, SIS ile lomber KMY arasında korelasyon bulunamamıştır (r=0.19, p=0.32). Hastalık süresi lomber KMY ile pozitif korelasyon (r=0.37, p=0.05), femur boyun KMY ile negatif korelasyon göstermiştir (r=-0.46, p=0.01). Klinik ve laboratuvar parametreler değerlendirildiğinde sabah tutukluğu, spinal ağrı, ESH ve CRP'nin KMY ile ilişkili olmadığı, yalnızca modifiye Schober testinin hem lomber hem de femur boyun KMY ile ilişkili olduğu görülmüştür.Sonuç: Ankilozan spondilit hastaları osteoporoz gelişim riski taşımaktadır. İlerlemiş hastalıkta lomber KMY değerleri paravertebral ossifikasyon ve kalsifikasyonlar nedeniyle yanıltıcı olarak yüksek bulunmaktadır. Bu nedenle, ilerlemiş AS hastalarında kemik kütle kaybının femur boyun bölgesinden değerlendirilmesi daha akılcı görünmektedir.

Anahtar Kelime:

Konular: Romatoloji

Ankilozan Spondilitli Hastalarda Kemik Mineral Yoğunluğunun Hastalık şiddeti ile ilişkisi

Öz:

Objective: This retrospective study was planned to determine the relationship between bone mineral density (BMD) and clinical, radiological and laboratory parameters in patients with ankylosing spondylitis (AS). Materials and Methods: The study group consisted of 28 patients with a mean disease duration of 11.9±6.1 years. In addition to clinical and demographic variables, lumbar and femoral BMD were evaluated with dual energy X-ray absorbtiometry. Lumbar spine score (LSS) and sacroiliac score (SIS) were calculated by grading of standard radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level were determined as laboratory parameters.Results: The rate of osteoporosis and osteopenia were 7.1% and 25% at the lumbar spine, and 14.2% and 17.8% at the femoral neck, respectively. LSS was significantly correlated with lumbar BMD (r=0.70, p<0.001), but not with femoral neck BMD (r=-0.11, p=0.55). SIS was negatively correlated with femoral neck BMD (r=-0.79, p<0.001), but not correlated with lumbar BMD (r=0.19, p=0.32). While lumbar BMD was positively correlated with disease duration (r=0.37, p=0.05), femoral neck BMD showed negative correlation with disease duration (r=-0.46, p=0.01). The evaluation of clinical paramaters and BMD showed that morning stiffness, spinal pain, ESR and CRP were not correlated with BMD. Only modified Schober's test was related to BMD on both lumbar spine and femoral neck.Conclusion: Ankylosing spondylitis patients are at risk for developing osteoporosis. In advanced disease, the lumbar BMD is misleadingly high because of paravertebral calcification and ossification. Therefore, it is more rational to evaluate the BMD at the femoral neck.

Anahtar Kelime:

Konular: Romatoloji

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

Sieper J, Braun J, Rudwaleit M, Bonen A, Zink A. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002; 61(Suppl III): 8-18.
Lange U, Kluge A, Strunk J. Ankylosing spondylitis and bone mineral density-what is the ideal tool for measurement. Rheumatol Int 2005; 26: 115-20.
El Maghraoui A. Osteoporosis and ankylosing spondylitis. Joint Bone Spine 2004; 71: 291-5.
Donnelly S, Doyle DV, Denton A, Rolfe I, McCloskey EV, Spector TD. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994; 53: 117-21.
Lee YS, Schlotzhauer T, Ott SM, van Vollenhoven RF, Hunter
J, Shapiro J, et al. Skeletal status of men with early and late ankylosing spondylitis. Am J Med 1997; 103: 203-41.
Maksymovych WP, Jhangri GS, Leclercq S, Skeith K, Yan A, Russell AS. An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 1998; 25: 714-7.
Allali F, Breban M, Procher R, Maillefert JF, Dougados M, Roux C. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor. Ann Rheum Dis 2003; 63: 347-9.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum1984; 27: 361-8.
Ralston SH, Urquhart GDK, Brzeski M, Sturrock RD. Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. BMJ 1990; 300: 563-5.
Mackay K, Mack C, Brophy S, Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI). Arthritis Rheum 1998; 41: 2263-70.
Gilgil E, Kacar C, Tuncer T, Butun B. The association of syndesmophytes with vertebral bone mineral density in patients with ankylosing spondylitis. J Rheumatol 2005; 32: 292-4.
de Vlam K, Mielants H, Veys EM. Involvement of the zygapophyseal joints in ankylosing spondylitis: relation to the bridging syndesmophytes. J Rheumatol 1999; 26: 1738-45.
Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137-48.
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137-41.
El Maghraoui, Borderie D, Cherruau B, Edouard R, Dougados M, Roux C. Osteoporozis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 1999; 26: 2205-9.
Speden DJ, Calin AI, Ring FJ, Bhalla AK. Bone mineral density, calcaneal ultrasound, and bone turnover markers in women with ankylosing spondylitis. J Rheumatol 2002; 29: 516-21.
Raltson SH, Urquhart GDK, Bzeski M, Sturrock RD. Prevalence of vertebral compression fracture rates in ankylosing spondylitis. Br Med J 1990; 300: 563-5.
Mitra D, Elvins DM, Speden DJ, Collins AJ. The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology 2000; 39: 85-9.
Sivri A, Kilinc S, Gokce-Kutsal Y, Ariyurek M. Bone mineral density in ankylosing spondylitis. Clin Rheumatol 1996; 15: 51-4.
Baek HJ, Kang SW, Lee YJ, Shin KC, Lee EB, Yoo CD, et al. Osteopenia in men with mild and severe ankylosing spondylitis. Rheumatol Int 2005; 26: 30-4.
Devogelaer JP, Maldague B, Malghem J, Nagant DC. Appendicular and vertebral bone mass in ankylosing spondylitis. A comparison of plain radiographs with single and dual-photon absorbtiometry and with quantitative computed tomography. Arthritis Rheum 1992; 35: 1062-7.
Jun JB, Joo KB, Her MY, Kim TH, Bae SC, YooDH, et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross- sectional study. J Rheumatol 2006; 33: 1637-41.
Meirelles ES, Borelli A, Camargo OP. Influence of disease activity and chronicity on ankylosing spondylitis bone massloss. Clin Rheumatol 1999; 18: 364-8.
Capaci K, Hepguler S, Argin M, Tas I. Bone mineral density in mild and advanced ankylosing spondylitis. Yonsei Med J 2003; 44: 379-84.
Karberg K, Zochling J, Sieper J, Felsenberg D, Braun J. Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 2005; 32: 1290-8.
Bronson WD, Walker SE, Hillman LS, Keisler LS, Hoyt T, Allen SH. Bone mineral density and biochemical markers of bone metabolism in ankylosing spondylitis. J Rheumatol 1998; 25: 929-35.
Mitra D, Elvins DM, Collins AJ. Biochemical markers of bone metabolism in mild ankylosing spondylitis and their relationship with bone mineral density and vertebral fractures. J Rheumatol 1999; 26: 2201-4.
Mullaji AB, Upadhyay SS, Ho EK. Bone mineral density in ankylosing spondylitis. DEXA comparison of control subjects with mild and advanced cases. J Bone Joint Surg Br 1994; 76: 660-5.
Reid DM, Nicoll JK, Kennedy NSJ, Smith MA, Tothill P, Nuki G. Bone mass in ankylosing spondylitis. J Rheumatol 1986; 13: 932-5.
Will R, Palmer R, Bhalla AK, Ring F, Calin A. Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet 1989; 23: 1483-5.
Juanola X, Mateo L, Nolla JM, Roig-Vilaseca D, Campoy E, Roig-Escofed D. Bone mineral density in women with ankylosing spondylitis. J Rheumatol 2000; 27: 1028-31.
Dos Santos FP, Constantin A, Laroche M, Destombes F, Bernard J, Mazieres B, et al. Whole body and regional bone mineral density in ankylosing spondylitis. J Rheumatol 2001; 28: 547-9.
Maillefert JF, Aho LS, El Maghraoui A, Dougados M, Roux C. Changes in bone density in patients with ankylosing spondylitis: a two-year follow-up study. Osteoporosis Int 2001; 12: 605-9.
Gratacos J, Collado A, Pons F, Osaba M, Sanmarti R, Roque M, et al. Significant bone mass in patients with early, active ankylosing spondylitis. Arthritis Rheum 1999; 42: 2319-24.
Toussirot E, Michel F, Wendling D. Bone density, ultrasound measurements and body composition in early ankylosing spondylitis. Rheumatology Oxford 2001; 40: 882-8.

APA	Ulusoy H, BİLGİCİ A, Kuru O, SARICA N, ARSLAN Ş, Erkorkmaz Ü (2010). Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. , 24 - 28.
Chicago	Ulusoy Hasan,BİLGİCİ Ayhan,Kuru Omer,SARICA Nebahat,ARSLAN Şule,Erkorkmaz Ünal Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. (2010): 24 - 28.
MLA	Ulusoy Hasan,BİLGİCİ Ayhan,Kuru Omer,SARICA Nebahat,ARSLAN Şule,Erkorkmaz Ünal Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. , 2010, ss.24 - 28.
AMA	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. . 2010; 24 - 28.
Vancouver	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. . 2010; 24 - 28.
IEEE	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü "Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis." , ss.24 - 28, 2010.
ISNAD	Ulusoy, Hasan vd. "Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis". (2010), 24-28.

APA	Ulusoy H, BİLGİCİ A, Kuru O, SARICA N, ARSLAN Ş, Erkorkmaz Ü (2010). Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. Turkish Journal of Rheumatology(.)Archives of Rheumatology, 25(1), 24 - 28.
Chicago	Ulusoy Hasan,BİLGİCİ Ayhan,Kuru Omer,SARICA Nebahat,ARSLAN Şule,Erkorkmaz Ünal Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. Turkish Journal of Rheumatology(.)Archives of Rheumatology 25, no.1 (2010): 24 - 28.
MLA	Ulusoy Hasan,BİLGİCİ Ayhan,Kuru Omer,SARICA Nebahat,ARSLAN Şule,Erkorkmaz Ünal Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. Turkish Journal of Rheumatology(.)Archives of Rheumatology, vol.25, no.1, 2010, ss.24 - 28.
AMA	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2010; 25(1): 24 - 28.
Vancouver	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis. Turkish Journal of Rheumatology(.)Archives of Rheumatology. 2010; 25(1): 24 - 28.
IEEE	Ulusoy H,BİLGİCİ A,Kuru O,SARICA N,ARSLAN Ş,Erkorkmaz Ü "Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis." Turkish Journal of Rheumatology(.)Archives of Rheumatology, 25, ss.24 - 28, 2010.
ISNAD	Ulusoy, Hasan vd. "Relationship Between Bone Mineral Density and Disease Activity in Patients with Ankylosing Spondylitis". Turkish Journal of Rheumatology(.)Archives of Rheumatology 25/1 (2010), 24-28.