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THE EFFECT OF DISEASE ACTIVITY AND HORMONAL FACTORS ON BONE MINERAL DENSITY IN MALE PATIENTS WITH ANKYLOSING SPONDYLITIS

Year 2013, Volume: 76 Issue: 3, 44 - 48, 30.09.2013

Abstract

Objectives: Osteoporosis is a common complication of ankylosing spondylitis (AS) and various factors may cause a reduction in bone mineral density (BMD).

Methods: In this study, the frequency of osteoporosis and the relationship between BMD and disease activity (BASDAI), functional status (BASFI), age, disease duration, body mass index (BMI), calcium, phosphorus, alkaline phosphatase, erythrocyte sedimentation rate, CRP, ferritin, intact parathyroid hormone, sex and thyroid hormones were investigated. Thirty four men with AS (mean age:35.4±10.7; mean disease duration:5.2±5.6 years) were enrolled.

Results: The measurement of lumbar spine and/or femoral neck BMD was under -2.5 SD in 13 patients (38.2%). Osteopenia or osteoporosis was detected at lumbar region in 19 patients (55.9%), and at femoral neck in 10 cases (29.4%). The values of BMD T-score were found -1.44±1.76 for lumbar spine, and -0.24±1.35 for femoral neck. Negative correlation was found between DHEA-S and lumbar T-score (r=-0.44, p=0.013) and lumbar Z-score (r=-0.58, p=0.003). Positive correlation was found between lumbar Z-score and estradiol (r=0.45, p=0.029) and homocysteine (r=0.68, p=0.004). For presence of osteoporosis, there was a positive correlation with DHEA-S (r=0.44, p=0.011), and negative correlation with estradiol (r=-0.39, p=0.029). When looking at the correlation between disease activity and osteoporosis, there was only negative correlation between BASFI and femoral neck Z-score (r=-0.47, p=0.027), and positive correlation between BASDAI and the presence of osteoporosis (r=0.40, p=0.025).

Conclusion: Osteoporosis is a common complication of young men with AS. Further studies are required to determine the factors that contribute to a reduction of bone density in AS.

References

  • Bessant R, Keat A. How should clinicians manage osteoporosis in ankylosing sponlylitis? J Rheumatol 2002;29:1511-19.
  • Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994;21:2281-5.
  • 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.
  • El Maghraoui A. Osteoporosis and ankylosing spondylitis. Joint Bone Spine 2004;71:291-5.
  • El Maghraoui A, Borderie d, Cherruau B, Edouard R, Dougados M, Roux C. Osteoporosis body composition and bone turnover in ankylosing spondylitis. J Rheumatol 1999;26:2205-9.
  • Franck H, Meurer T, Hofbauer LC. Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism, and osteoprotegerin serum levels in patients with ankylosing spondylitis. J Rheumatol 2004;31(11):2236-41.
  • Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21:2286
  • Geusens P, Vosse D, van der Linden S. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2007;19:335-9.
  • Giltay EJ, van Schaardenburg D, Gooren LJ, PoppSnijders C, Dijkmans BA. Androgens and ankylosing spondylitis: a role in pathogenesis? Annals of the New York Academy of Sciences 1999;22:340-364.
  • Goei The HS, Steven MM, van der Linden SM, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York criteria in patients with positive clinical history screening test for ankylosing spondylitis. Br J Rheumatol 1985;24:242-9.
  • Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359(9321):1929-36.
  • 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(7):1290-8.
  • Meirelles Es, Borelli A, Camargo OP. Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. Clin Rheumatol 1999;18:364-8.
  • Mitra D, Elvins DM, Collins AJ. Testosterone and testosterone free index in mild ankylosing spondylitis: relationship with bone mineral density and vertebral fractures. J Rheumatol 1999;306:558.
  • 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.
  • Mullaji AB, Upadhyay SS, Ho EK. Bone mineral density in ankylosing spondylitis. DXA comparison of control subjects with mild and advanced cases. Br J Bone Joint Surg 1994;76-B:660-5.
  • Sieper J, Appel H, Braun J, Rudwaleit M. Critical apprasial of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes. Arthritis Rheum 2008;58:649-56.
  • Will R, Palmer R, Bhalla AK, Ring F, Calin A. Osteoporosis in early ankylosing spondylitis. A primary pathological event? Lancet 1989;ii:1483-5.

ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ

Year 2013, Volume: 76 Issue: 3, 44 - 48, 30.09.2013

Abstract

Amaç: Osteoporoz ankilozan spondilitin (AS) sık rastlanan bir komplikasyonudur ve çeşitli faktörler kemik mineral yoğunluğunda (KMY) azalmaya neden olabilmektedir.

Yöntem: Bu çalışmada; AS’li hastalarda osteoporoz sıklığı ve KMY’deki azalma ile hastalık aktivitesi (BASDAI), fonksiyonel durum (BASFI), yaş, hastalık süresi, beden kitle indeksi (BKİ), kalsiyum, fosfor, alkalen fosfataz, eritrosit sedimentasyon hızı, CRP, ferritin, intakt parathormon, cinsiyet ve tiroid hormonları arasındaki ilişki araştırıldı. AS’li 34 erkek hasta (ortalama yaş: 35,4±10,7; ortalama hastalık süresi: 5,2±5,6 yıl) çalışmaya alındı.

Bulgular: Lomber vertebra ve/veya femur boynu KMY ölçümü 13 hastada (%38,2) -2,5 SD’nin altında idi. Hastaların 19’unda (%55,9) lomber bölgede, 10’unda (%29,4) femur boynunda osteopeni veya osteoporoz saptandı. KMY T-skoru ortalama değerleri lomber vertebra için -1,44±1,76, femur boynu için -0,24±1,35 bulundu. DHEA-S ile lomber T-skoru (r=-0.44, p=0.013) ve lomber Z-skoru (r=-0.58, p=0.003) arasında negatif korelasyon saptandı. Östradiol (r=0.45, p=0.029) ve Homosistein (r=0.68, p=0.004) ile lomber Z-skoru arasında pozitif korelasyon saptandı. Osteoporoz varlığı açısından DHEA-S ile pozitif (r=0.44, p=0.011), östradiol ile negatif (r=-0.39, p=0.029) korelasyon vardı. Hastalık aktivitesi ile osteoporoz arasında korelasyona bakıldığında BASFİ ile femur boynu Z-skoru arasında negatif korelasyon (r=-0.47, p=0.027), osteoporoz varlığı ile BASDAİ arasında ise pozitif korelasyon (r=0.40, p=0.025) olduğu görüldü.

Sonuç: AS’li genç erkeklerde osteoporoz sık görülen bir komplikasyondur. AS’de kemik yoğunluğunda azalmaya katkıda bulunan faktörlerin belirlenmesi için başka çalışmalar gereklidir.

References

  • Bessant R, Keat A. How should clinicians manage osteoporosis in ankylosing sponlylitis? J Rheumatol 2002;29:1511-19.
  • Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994;21:2281-5.
  • 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.
  • El Maghraoui A. Osteoporosis and ankylosing spondylitis. Joint Bone Spine 2004;71:291-5.
  • El Maghraoui A, Borderie d, Cherruau B, Edouard R, Dougados M, Roux C. Osteoporosis body composition and bone turnover in ankylosing spondylitis. J Rheumatol 1999;26:2205-9.
  • Franck H, Meurer T, Hofbauer LC. Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism, and osteoprotegerin serum levels in patients with ankylosing spondylitis. J Rheumatol 2004;31(11):2236-41.
  • Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994;21:2286
  • Geusens P, Vosse D, van der Linden S. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2007;19:335-9.
  • Giltay EJ, van Schaardenburg D, Gooren LJ, PoppSnijders C, Dijkmans BA. Androgens and ankylosing spondylitis: a role in pathogenesis? Annals of the New York Academy of Sciences 1999;22:340-364.
  • Goei The HS, Steven MM, van der Linden SM, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a comparison of the Rome, New York and modified New York criteria in patients with positive clinical history screening test for ankylosing spondylitis. Br J Rheumatol 1985;24:242-9.
  • Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002;359(9321):1929-36.
  • 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(7):1290-8.
  • Meirelles Es, Borelli A, Camargo OP. Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. Clin Rheumatol 1999;18:364-8.
  • Mitra D, Elvins DM, Collins AJ. Testosterone and testosterone free index in mild ankylosing spondylitis: relationship with bone mineral density and vertebral fractures. J Rheumatol 1999;306:558.
  • 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.
  • Mullaji AB, Upadhyay SS, Ho EK. Bone mineral density in ankylosing spondylitis. DXA comparison of control subjects with mild and advanced cases. Br J Bone Joint Surg 1994;76-B:660-5.
  • Sieper J, Appel H, Braun J, Rudwaleit M. Critical apprasial of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes. Arthritis Rheum 2008;58:649-56.
  • Will R, Palmer R, Bhalla AK, Ring F, Calin A. Osteoporosis in early ankylosing spondylitis. A primary pathological event? Lancet 1989;ii:1483-5.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Clinical Research
Authors

Ayten Yazıcı

Ayşe Çefle This is me

Ahmet Eminler

Hakan Demir

Publication Date September 30, 2013
Submission Date October 29, 2012
Published in Issue Year 2013 Volume: 76 Issue: 3

Cite

APA Yazıcı, A., Çefle, A., Eminler, A., Demir, H. (2013). ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ. Journal of Istanbul Faculty of Medicine, 76(3), 44-48.
AMA Yazıcı A, Çefle A, Eminler A, Demir H. ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ. İst Tıp Fak Derg. September 2013;76(3):44-48.
Chicago Yazıcı, Ayten, Ayşe Çefle, Ahmet Eminler, and Hakan Demir. “ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ”. Journal of Istanbul Faculty of Medicine 76, no. 3 (September 2013): 44-48.
EndNote Yazıcı A, Çefle A, Eminler A, Demir H (September 1, 2013) ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ. Journal of Istanbul Faculty of Medicine 76 3 44–48.
IEEE A. Yazıcı, A. Çefle, A. Eminler, and H. Demir, “ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ”, İst Tıp Fak Derg, vol. 76, no. 3, pp. 44–48, 2013.
ISNAD Yazıcı, Ayten et al. “ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ”. Journal of Istanbul Faculty of Medicine 76/3 (September 2013), 44-48.
JAMA Yazıcı A, Çefle A, Eminler A, Demir H. ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ. İst Tıp Fak Derg. 2013;76:44–48.
MLA Yazıcı, Ayten et al. “ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ”. Journal of Istanbul Faculty of Medicine, vol. 76, no. 3, 2013, pp. 44-48.
Vancouver Yazıcı A, Çefle A, Eminler A, Demir H. ANKİLOZAN SPONDİLİTLİ ERKEK HASTALARDA HASTALIK AKTİVİTESİ VE HORMONAL FAKTÖRLERİN KEMİK MİNERAL YOĞUNLUĞU ÜZERİNE ETKİSİ. İst Tıp Fak Derg. 2013;76(3):44-8.

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