Clin Osteol 2010; 15(2): 51-56

Osteoporosis in spondylarthritidesReview articles

K. Pavelka

Spondyloarthritis is a group of inflammatory rheumatic diseases involving the spine, peripheral joints and periarticular soft tissues, having frequent extraskeletal manifestations. Ankylosing spondylitis (AS) is the most frequent entity, with the highest prevalence of osteoporosis (OP). The prevalence of OP in AS cohort studies is 19-62 %. Bone mineral density (BMD) assessment is methodically difficult in the lumbosacral spine where the presence of syndesmophytes interferes with measurement. Therefore, it is more conveni­ ent to measure BMD in the femoral neck or to use QCT of the lumbar spine. Decreases BMD correlates with disease duration, AS ac­ tivit ment. The prevalence of vertebral fractures in AS in longitudinal studies varies according to methodologies used. The relative risk of ver­ tebral fractures is increased (odds ratio 7.7, 95% CI 4.3-12.6). les than in females, reaching a maximum of 17% after 20-30 years. AS is characterized by both typical and atypical osteoporotic fractures. Fractures in AS quite often involve the cervical spine. The frac­ tures frequently involve the posterior structures of the vertebrae and their pedicles. There are also transvertebral fractures with va­ riable degrees of dislocation or transdiscal fractures over pedicles. During radiographic evaluation, it is necessary to differentiate these changes from those typical for AS such as spondylodiscitis (Romanus lesion). Neurological complications are more frequent in AS ver­ tebral fractures than in osteoporotic fractures of other aetiology. These complications include spinal cord lesions, nerve root lesions and paravertebral haematomas resulting in variable degrees of sensory or motor deficits. Lat arthrosis or instability of the dorsal arch, resulting in increased morbidity and mortality. Evaluation of BMD by DXA or other alternative methods should be a part of the monitoring algorithm of patients with AS. The pre­ vention and therapy of OP in AS should employ the same principles as in primary OP. An important part of therapy is suppression of the activity of AS. Most efficient are anti-TNF agents. The first open studies have shown a decrease in resorption markers and incre­ ase in BMD after therapy with etanercept and infliximab. Besides gular daily exercise.

Keywords: ankylosing spondylitis, osteoporosis, anti-TNF therapy

Published: December 11, 2010  Show citation

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Pavelka K. Osteoporosis in spondylarthritides. Osteologický bulletin. 2010;15(2):51-56.
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