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Bone microarchitecture in ankylosing spondylitis and the association with bone mineral density, fractures and syndesmophytes

Journal article
Authors Eva Klingberg
Mattias Lorentzon
Jan Göthlin
Dan Mellström
Mats Geijer
Claes Ohlsson
Elizabeth J. Atkinson
Sundeep Khosla
Hans Carlsten
Helena Forsblad d'Elia
Published in Arthritis Research & Therapy
Volume 2013
Issue 15:R179
ISSN 1478-6362
Publication year 2013
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Centre for Bone and Arthritis Research
Institute of Medicine
Institute of Clinical Sciences, Department of Radiology
Language en
Keywords ankylosing spondylitis, osteoporosis, bone microarchitecture
Subject categories Rheumatology and Autoimmunity


Introduction Osteoporosis of the axial skeleton is a known complication of ankylosing spondylitis (AS), but bone loss affecting the peripheral skeleton is less studied. This study on volumetric bone mineral density (vBMD) and bone microarchitecture in AS was conducted to compare peripheral vBMD in AS patients with healthy controls, to study vBMD in axial compared with peripheral bone and to explore the relationship between vertebral fractures, spinal osteoproliferation and peripheral bone microarchitecture and density. Methods High-resolution peripheral quantitative computed tomography (HRpQCT) of ultra-distal radius and tibia and QCT and dual energy x-ray absorptiometry (DXA) of lumbar spine were performed in 69 male AS-patients (NY-criteria). Spinal radiographs were assessed for vertebral fractures and syndesmophyte formation (mSASSS). The HRpQCT measurements were compared with the measurements of healthy controls. Results The AS patients had lower cortical vBMD in radius (p=0.004) and lower trabecular vBMD in tibia (p=0.033), than the controls. Strong correlations were found between trabecular vBMD in lumbar spine, radius (rS=0.762; p<0.001) and tibia (rS=0.712; p<0.001). When compared with age-matched AS controls, patients with vertebral fractures had lower lumbar cortical vBMD (-22%; p=0.019), lower cortical cross-sectional area in radius (-28.3%; p=0.001) and tibia (-24.0%; p=0.013) and thinner cortical bone in radius (-28.3%; p=0.001) and tibia (-26.9%; p=0.016). mSASSS correlated negatively with trabecular vBMD in lumbar spine (rS=-0.620; p<0.001), radius (rS=-0.400; p=0.001) and tibia (rS=-0.475; p<0.001) and also with trabecular thickness in radius (rS=-0.528; p<0.001) and tibia (rS=-0.488; p<0.001). Adjusting for age, syndesmophytes were significantly associated with decreasing trabecular vBMD, but increasing cortical vBMD in lumbar spine, but not with increasing cortical thickness or density in peripheral bone. Estimated lumbar vBMD by DXA correlated with trabecular vBMD measured by QCT (rS=0.636; p<0.001). Conclusions Lumbar osteoporosis, syndesmophytes and vertebral fractures were associated with both lower vBMD and deteriorated microarchitecture in peripheral bone. The results indicate that trabecular bone loss is general, whereas osteoproliferation is local in AS.

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