More information about text formats
Authors of the referred article, Vosse D et al., found a higher incidence of vertebral fractures in patients with ankylosing spondylitis (AS), but not with non-vertebral fractures. Spinal fractures are common in AS patients (7 times more frequent then in healthy individuals), appear spontaneously after minor traumas, usually are unstable and often complicated [1-5]. Bone mineral density is reduced in those...
Authors of the referred article, Vosse D et al., found a higher incidence of vertebral fractures in patients with ankylosing spondylitis (AS), but not with non-vertebral fractures. Spinal fractures are common in AS patients (7 times more frequent then in healthy individuals), appear spontaneously after minor traumas, usually are unstable and often complicated [1-5]. Bone mineral density is reduced in those patients, especially males, which we observed in our group of AS patients too.
Syndesmophytes and Andersson´s lesions also tend to creation of fractures. Most common are fractures in the lower cervical spine or extension fractures in thoracolumbar region [4-6]. Diagnostics of fractures is
problematic, since some are occult on plain radiographic or magnetic resonance imaging (MR), which we observed in our set of patients as well.
Fractures in low thoracic or lumbar vertebrae may be usefully evaluated by dual-energy X-ray absorptiometry. MR offers the possibility of scoring acute/active inflammation with possible use of fat saturation, gradient
and other special sequences. In particular, various types of signal suppression of fat in this direction seem to be beneficial [7-9].
Complicated fractures can be displayed perfectly just using multiple-spiral computed tomography [3,4]. The article of Vosse D et al. also brought new facts about reducing the risk of fractures in patients with AS in the
present treatment by non-steroidal anti-inflammatory drugs (NSAID’s). The other clinical data indicate that cyclooxygenase type 2-selective (COX-2) inhibitors use, may be beneficial for healing of some skeleton injuries. In
contrast, chronic use of COX-2 NSAIDs may impair normal skeletal function leading to decreased bone mineral density in older males and some experimental studies documented their negative effects on healing of
skeletal tissues, if the defect has already occurred. Nothing has been found about NSAID's own readiness to create vertebral fractures so far.
1. Harrop JS, Sharan A, Anderson G, Hillibrand AS, Albert TJ, Flanders A, et al. Failure of standard imaging to detect a cervical fracture in a patient with ankylosing spondylitis. Spine 2005;30(14):E417-9.
2. Madsen OR. Bone mineral density and fracture risk in patients with ankylosing spondylitis. Review. Ugeskr Laeger 2008;170(48):3956-60.
3. Peterová V, Forejtová Š. Complex morphological investigations in patients with ankylosing spondylitis. Èes Revmatol 2006;14:71-9.
4. de Peretti F, Sane JC, Dran G, Razafindratsiva C, Argenson C. Ankylosed spine fractures with spondylitis or diffuse idiopathic skeletal hyperostosis: diagnosis and complications. Rev Chir Othop Reparatrice Appar Mot 2004; 90(5):456-65.
5. Altenbernd J, Bitu S, Lemburg S, Peters S, Seybold D, Meindl R, Nicolas V, Heyer CM. Vertebral fractures in patients with ankylosing spondylitis: a retrospective analysis of 66 patients. Rofo 2009;181(1):45-53.
6. Hitchon PW, From AM, Brenton MD, Glaser JA, Torner JC. Fractures of the thoracolumbar spine complicating ankylosing spondylitis. J Neurosurg 2002;97(2 Suppl):218-22.
7. Braun J, Rudwaleit M, Hermann KG, Rau R. Imaging in ankylosing spondylitis. Z Rheumatol 2007;66(2):167-78.
8. Peterová V, Forejtová Š, Pavelka K. Correlation of Some MR Findings in Ankylosing Spondylitis. Prague Medical report 2006;107:26-36.
9. Forejtová Š, Peterová V, Havelka S, Pavelka K. Selection of MR sequences in ankylosing spondylitis patients. Ann Rheum Dis 2004;63(Suppl. 1):537.
10. O'Connor JP, Lysz T. Celecoxib, NSAIDs and the skeleton. Review. Drugs Today 2008;44(9):693-709.