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Open Access 01-05-2011 | Original Article

The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis

Authors: S. Arends, A. Spoorenberg, G. A. W. Bruyn, P. M. Houtman, M. K. Leijsma, C. G. M. Kallenberg, E. Brouwer, E. van der Veer

Published in: Osteoporosis International | Issue 5/2011

Abstract

Summary

Osteoporosis is a well recognized complication of ankylosing spondylitis (AS). This study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis, and that bone turnover markers (BTM) are valuable markers to detect bone loss in AS.

Introduction

The aim of this study was to elucidate the pathophysiology of AS-related osteoporosis by investigating the relation between bone mineral density (BMD), BTM, vitamin D, and clinical assessments of disease activity and physical function, as well as to identify parameters that are related to low BMD (osteopenia or osteoporosis) in AS patients with active disease.

Methods

One hundred twenty-eight consecutive Dutch AS outpatients were included in this cross-sectional study. Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), C-reactive protein, ASAS-endorsed disease activity score (ASDAS), Bath AS Functional Index (BASFI), bone formation markers procollagen type 1 N-terminal peptide (PINP) and osteocalcin (OC), bone resorption marker serum C-telopeptides of type I collagen (sCTX), 25-hydroxyvitamin D (25OHvitD), lumbar spine and hip BMD, and vertebral fractures were assessed. Z-scores of BTM were calculated using matched 10-year cohorts of a Dutch reference group to correct for the normal influence that age and gender have on bone turnover.

Results

sCTX Z-score, OC Z-score, BASDAI, age, and gender were independently related to low BMD. In addition, PINP Z-score, ESR, 25OHvitD, age, and gender were independently related to sCTX and/or OC Z-score.

Conclusions

This study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis. Furthermore, sCTX and OC Z-scores seem to be valuable markers to detect bone loss in AS patients in daily clinical practice where BMD of the lumbar spine, measured by DXA, may be overestimated due to osteoproliferation in patients with advanced AS.

Cooper C, Carbone L, Michet CJ et al (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21(10):1877–1882PubMed

Vosse D, Landewe R, van der Heijde D et al (2009) Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 68(12):1839–1842PubMedCrossRef

Geusens P, Vosse D, van der Linden S (2007) Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 19(4):335–339PubMedCrossRef

Franck H, Meurer T, Hofbauer LC (2004) Evaluation of bone mineral density, hormones, biochemical markers of bone metabolism, and osteoprotegerin serum levels in patients with ankylosing spondylitis. J Rheumatol 31(11):2236–2241PubMed

Ghozlani I, Ghazi M, Nouijai A et al (2009) Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 44(5):772–776PubMedCrossRef

Gratacos J, Collado A, Pons F et al (1999) Significant loss of bone mass in patients with early, active ankylosing spondylitis: a followup study. Arthritis Rheum 42(11):2319–2324PubMedCrossRef

Lange U, Teichmann J, Strunk J et al (2005) Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis. Osteoporos Int 16(12):1999–2004PubMedCrossRef

Maillefert JF, Aho LS, El Maghraoui A et al (2001) Changes in bone density in patients with ankylosing spondylitis: a two-year follow-up study. Osteoporos Int 12(7):605–609PubMedCrossRef

Toussirot E, Ricard-Blum S, Dumoulin G et al (1999) Relationship between urinary pyridinium cross-links, disease activity and disease subsets of ankylosing spondylitis. Rheumatology 38(1):21–27PubMedCrossRef

10.

El Maghraoui A (2004) Osteoporosis and ankylosing spondylitis. Joint Bone Spine 71(4):291–295PubMedCrossRef

11.

Lange U, Jung O, Teichmann J et al (2001) Relationship between disease activity and serum levels of vitamin D metabolites and parathyroid hormone in ankylosing spondylitis. Osteoporos Int 12(12):1031–1035PubMedCrossRef

12.

Mermerci Baskan B, Pekin Dogan Y, Sivas F et al (2009) The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int. doi:10.1007/s00296-009-0975-7 PubMed

13.

Obermayer-Pietsch BM, Lange U, Tauber G et al (2003) Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis. Osteoporos Int 14(12):995–1000PubMedCrossRef

14.

Borman P, Bodur H, Bingol N et al (2001) Bone mineral density and bone turnover markers in a group of male ankylosing spondylitis patients: relationship to disease activity. J Clin Rheumatol 7(5):315–321PubMedCrossRef

15.

Park MC, Chung SJ, Park YB et al (2008) Bone and cartilage turnover markers, bone mineral density, and radiographic damage in men with ankylosing spondylitis. Yonsei Med J 49(2):288–294PubMedCrossRef

16.

Eastell R, Hannon RA (2008) Biomarkers of bone health and osteoporosis risk. Proc Nutr Soc 67(2):157–162PubMedCrossRef

17.

El Maghraoui A, Tellal S, Chaouir S et al (2005) Bone turnover markers, anterior pituitary and gonadal hormones, and bone mass evaluation using quantitative computed tomography in ankylosing spondylitis. Clin Rheumatol 24(4):346–351PubMedCrossRef

18.

Karberg K, Zochling J, Sieper J et al (2005) Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 32(7):1290–1298PubMed

19.

Sarikaya S, Basaran A, Tekin Y et al (2007) Is osteoporosis generalized or localized to central skeleton in ankylosing spondylitis? J Clin Rheumatol 13(1):20–24PubMedCrossRef

20.

Yilmaz N, Ozaslan J (2000) Biochemical bone turnover markers in patients with ankylosing spondylitis. Clin Rheumatol 19(2):92–98PubMedCrossRef

21.

Vosse D, Landewe R, Garnero P et al (2008) Association of markers of bone- and cartilage-degradation with radiological changes at baseline and after 2 years follow-up in patients with ankylosing spondylitis. Rheumatology 47(8):1219–1222PubMedCrossRef

22.

Kanis JA, McCloskey EV, Johansson H et al (2008) A reference standard for the description of osteoporosis. Bone 42(3):467–475PubMedCrossRef

23.

Baek HJ, Kang SW, Lee YJ et al (2005) Osteopenia in men with mild and severe ankylosing spondylitis. Rheumatol Int 26(1):30–34PubMedCrossRef

24.

Lee YS, Schlotzhauer T, Ott SM et al (1997) Skeletal status of men with early and late ankylosing spondylitis. Am J Med 103(3):233–241PubMedCrossRef

25.

Meirelles ES, Borelli A, Camargo OP (1999) Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. Clin Rheumatol 18(5):364–368PubMedCrossRef

26.

Lange U, Kluge A, Strunk J et al (2005) Ankylosing spondylitis and bone mineral density—what is the ideal tool for measurement? Rheumatol Int 26(2):115–120PubMedCrossRef

27.

Bessant R, Keat A (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29(7):1511–1519PubMed

28.

van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368PubMedCrossRef

29.

Braun J, Davis J, Dougados M et al (2006) First update of the international ASAS consensus statement for the use of anti-TNF agents in patients with ankylosing spondylitis. Ann Rheum Dis 65(3):316–320PubMedCrossRef

30.

Garrett S, Jenkinson T, Kennedy LG et al (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291PubMed

31.

Lukas C, Landewe R, Sieper J et al (2009) Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 68(1):18–24PubMedCrossRef

32.

van der Heijde D, Lie E, Kvien TK et al (2009) ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 68(12):1811–1818PubMedCrossRef

33.

Calin A, Garrett S, Whitelock H et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285PubMed

34.

Kanis JA (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int 4(6):368–381PubMedCrossRef

35.

Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148PubMedCrossRef

36.

Amento EP (1987) Vitamin D and the immune system. Steroids 49(1–3):55–72PubMedCrossRef

Title: The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis
Authors: S. Arends
A. Spoorenberg
G. A. W. Bruyn
P. M. Houtman
M. K. Leijsma
C. G. M. Kallenberg
E. Brouwer
E. van der Veer
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 5/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1338-7

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The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis

Abstract

Summary

Introduction

Methods

Results

Conclusions

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Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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