Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.298
Peer-review started: February 8, 2014
First decision: April 4, 2014
Revised: August 15, 2014
Accepted: September 4, 2014
Article in press: September 10, 2014
Published online: March 18, 2015
AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis (SpA) particularly those studies using dual X-ray absorptiometry (DXA) methods.
METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis (AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineral density, osteoporosis (OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with SpA were eligible. Each article was reviewed and the key elements were noted.
RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axSpA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with SpA varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.
CONCLUSION: Bone loss may be determined in patients with axSpA at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation (bone marrow edema) at the vertebral colon.
Core tip: Osteoporosis is a well-known problem in patients with ankylosing spondylitis and other forms of spondyloarthritis. It may begin even in the early stages of the disease and inevitably causes vertebral fractures. Bone loss can be prevented with tumor necrosis factor blocking therapy by reducing inflammation at skeletal sites. Dual X-ray absorptiometry (DXA) is the preferred method to assess bone mass in the early stages of the disease or in patients without aberrant ossification of the spine. In advanced cases DXA measurements with lateral spinal projections or quantitative computed tomography may be referred.