Bone tissue metabolism in men with ankylosing spondylitis

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ABSTRACT

Purpose

The aim of the study was the composite estimation of bone tissue metabolism in ankylosing spondylitis (AS) after having taken into account such factors as a high risk of incidence of osteoporosis in patients with AS and potential danger of permanent immobility.

Material and Methods

Sixty- six patients with established diagnosis of AS and 63 healthy individuals in the control group were included into the study. To measure bone mineral density (BMD) the dual energy X-ray absorptiometry (DEXA) method was used. Additionally, biochemical markers of osteoporosis such as bone fraction of an alkaline phosphatase (BALP), osteocalcin (BGP) and deoxypyridinoline (Dpd) as well as many inflammatory markers of disease activity have been determined.

Results

In our study with AS had significantly diminished bone mineral density, as compared with health controls. The presence of osteopenia/osteoporosis was associated with longer duration of the disease and with higher age. In the overall group of AS patients bone degradation marker, Dpd, correlated with serum concentration of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and C-reactive protein (CRP), and inversely with BMD measured in the forearm. However, no direct association could be revealed between lower bone density and markers of inflammation or inflammatory cytokines, except of IL-6 witch was significantly higher in AS patients with osteoporosis/ osteopenia than those without.

Conclusions

Our results indicate that disease duration and higher age are risk factors for osteoporosis in patients with AS. Inflammation might contribute to the accelerated bone loss in AS through stimulation of bone degradation.

Section snippets

INTRODUCTION

Osteoporosis is now known to occur in association will all patterns of chronic inflammatory joint disease. Osteoporosis associated with ankylosing spondylitis (AS) seems to be of the secondary nature. Even slight injury can cause fracture within vertebral column and make patients seriously physically handicapped in consequence. Comprehensive studies of mechanisms responsible for osteoporosis associated with AS are essential to develop effective prophylactic antiresorptive treatment for AS

MATERIALS AND METHODS

The diagnosis of AS was established on the basis of modified New York Criteria [2]. The Bath ankylosing spondylitis disease activity index (BASDAI) score were used to measure disease activity (on a scale of 0–10) [3]. The mean BASDAI was 3.71 ± 1.6 (median 3.82). Each patient had diagnosis confirmed by radiological examination of the sacroiliac joints, which revealed bilateral lesions in stage 2 to 4. Protocol of the study was approved by the Bioethical Comity of the University of Medical

An assessment of BMD in distal part of forearm

BMD values for AS patients varied from case to case but were generally rated between 0.304 g/cm2 and 0.632 g/cm2; an average value was 0.522 g/cm2 ± 0.067; median 0.531 g/cm2. BMD values in the group of AS patients with normal T score oscillated between 0.556 g/cm2 and 0.632 g/cm2, an average value 0.588 g/cm2 ± 0.025, median 0.582 g/cm2, whereas in the group of AS patients with osteopenia or osteoporosis the BMD values oscillated between 0.304 g/cm2 to 0.555 g/cm2, an average value 0.492 g/cm2

DISCUSSION

Abnormal bone structure, impaired elasticity and accompanying bone mass loss are characteristic features of AS [4]. The main factor responsible for the development of osteoporosis in AS patient is an active local and general inflammation process. In male other factors such us: long – term corticoid therapy (16.4%), alcoholism (16%), tobacco smoking (14.6%), hypogonadism (10.1%), hypercalciuria, chronic liver illnesses, Crohn's disease, low calcium diet, hyperthyroidism and immobilization can

CONCLUSIONS

Based on the obtained data our results suggest that there was an accelerated loss of bone tissue observed in patients with AS compared to the healthy population. The presence of osteopenia/osteoporosis was associated with longer duration of the disease and with higher age. In the overall group of AS patients bone degradation marker, Dpd, correlated with serum concentration of IL-6, TNF-alpha and CRP, and inversely with BMD measured in the forearm. However, no direct association could be

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