Bone Mineral Density and Fracture Risk in Ankylosing Spondylitis: A Meta-Analysis
- 590 Downloads
We conducted a meta-analysis of studies to examine the risk of vertebral and non-vertebral fractures in patients with ankylosing spondylitis (AS). Additionally, we evaluated the risk factors of vertebral fractures in AS. Two authors independently searched Embase and Medline for studies that had assessed the risk of fractures in patients with AS. Twenty-two studies were eligible for the meta-analysis. Patients with AS had high frequency of vertebral fractures [OR (95% CI): 1.96 (1.52–2.51)]. Major risk factors for vertebral fractures in patients with AS include low BMD at the femoral neck and total hip, male gender, longer disease duration, higher BASDAI, higher BASRI, and possibly inflammatory bowel disease. The risk of non-vertebral fractures [OR (95% CI) 1.10 (1.04–1.15)] was 10% higher in AS patients than in controls. The risk of hip fractures in AS patients was not statistically significant [OR (95% CI) 1.17 (0.71–1.92)] in our pooled analysis. We found that patients with AS are at high risk of vertebral fractures. Male sex, duration of AS, mSASSS, BASRI, and low BMD at the hip and distal forearm were associated with the risk of vertebral fractures. Current evidence on the risk of hip fractures in patients with AS is inconsistent. Data about the effect of NSAIDs and TNF inhibitors on fracture risk in AS are limited.
KeywordsFractures Osteoporosis Bone mineral density Ankylosing spondylitis Spondyloarthropathy
Compliance with Ethical Standards
Conflict of interest
Nisha Nigil Haroon has received fellowship support from an unrestricted research Grant supported by AMGEN. Cara Pray, Neelufer Irene Feroz and Nisha Nigil Haroon have no conflict of interest.
Human and Animal Rights
This article does not contain any studies with animals performed by any of the authors.
For this type of study formal consent is not required.
- 6.van der Weijden MA, Claushuis TA, Nazari T, Lems WF, Dijkmans BA, van der Horst-Bruinsma IE (2012) High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review. Clin Rheumatol 31(11):1529–1535CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Schiefer TK, Milligan BD, Bracken CD, Jacob JT, Krauss WE, Pichelmann MA, Clarke MJ (2014) In-hospital neurologic deterioration following fractures of the ankylosed spine: a single-institution experience. World Neurosurg 83(5):775–783Google Scholar
- 12.Montala N, Juanola X, Collantes E, Munoz-Gomariz E, Gonzalez C, Gratacos J, Zarco P, Fernandez Sueiro JL, Mulero J, Torre-Alonso JC, Batlle E, Carmona L (2011) Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis. J Rheumatol 38:893–897CrossRefPubMedGoogle Scholar
- 13.Muñoz-Ortego J, Vestergaard P, Rubio JB, Wordsworth P, Judge A, Javaid MK, Arden NK, Cooper C, Diez-Perez A, Prieto-Alhambra D (2014) Ankylosing spondylitis is associated with an increased risk of vertebral and non-vertebral clinical fractures: a population-based cohort study. J Bone Miner Res 29(8):1770–1776CrossRefPubMedGoogle Scholar
- 24.Arends S, Spoorenberg A, Bruyn GA, Houtman PM, Leijsma MK, Kallenberg CG, Brouwer E, van der Veer E (2011) The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis. Osteoporos Int 22(5):1431–1439CrossRefPubMedGoogle Scholar
- 26.Cooper C, Carbone L, Michet CJ, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21:1877–1882Google Scholar
- 31.Klingberg E, Geijer M, Gothlin J, Mellstrom D, Lorentzon M, Hilme E, Hedberg M, Carlsten H, Forsblad-D’Elia H (2012) Vertebral fractures in ankylosing spondylitis are associated with lower bone mineral density in both central and peripheral skeleton. J Rheumatol 39:1987–1995CrossRefPubMedGoogle Scholar
- 32.Klingberg E, Lorentzon M, Göthlin J, Mellström D, Geijer M, Ohlsson C, Atkinson EJ, Khosla S, Carlsten H, Forsblad-d’Elia H (2013) Bone microarchitecture in ankylosing spondylitis and the association with bone mineral density, fractures, and syndesmophytes. Arthritis Res Ther 15(6):R179CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Ulu MA, Batmaz I, Dilek B, Cevik R (2014) Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis. Chin Med J (Engl) 127(15):2740–2747Google Scholar
- 38.Kawai VK, Grijalva CG, Arbogast PG, Curtis JR, Solomon DH, Delzell E, Chen L, Ouellet-Hellstrom R, Herrinton L, Liu L, Mitchell EF Jr, Stein CM, Griffin MR (2013) Initiation of tumor necrosis factor α antagonists and risk of fractures in patients with selected rheumatic and autoimmune diseases. Arthritis Care Res (Hoboken) 65(7):1085–1094CrossRefGoogle Scholar
- 40.Maas F, Spoorenberg A, Brouwer E, Schilder AM, Chaudhry RN, Wink F, Bootsma H, van der Veer E, Arends S (2016) Radiographic vertebral fractures develop in patients with ankylosing spondylitis during 4 years of TNF-α blocking therapy. Clin Exp Rheumatol 34(2):191–199Google Scholar
- 41.Lukasiewicz AM, Bohl DD, Varthi AG, Basques BA, Webb ML, Samuel AM, Grauer JN (2016) Spinal fracture in patients with ankylosing spondylitis: cohort definition, distribution of injuries, and hospital outcomes. Spine (Phila Pa 1976) 41(3):191–196Google Scholar
- 42.Maas F, Spoorenberg A, van der Slik BP, van der Veer E, Brouwer E, Bootsma H, Bos R, Wink FR, Arends S (2016) Clinical risk factors for the presence and development of vertebral fractures in patients with ankylosing spondylitis. Arthritis Care Res (Hoboken). doi: 10.1002/acr.22980
- 43.Geusens P, De Winter L, Quaden D, Vanhoof J, Vosse D, van den Bergh J, Somers V (2015) The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma. Arthritis Res Ther 17:294Google Scholar
- 45.Haroon NN, Szabo E, Raboud JM, Mcdonald-Blumer H, Fung L, Josse RG, Inman RD, Cheung AM (2015) Alterations of bone mineral density, bone microarchitecture and strength in patients with ankylosing spondylitis: a cross-sectional study using high-resolution peripheral quantitative computerized tomography and finite element analysis. Arthritis Res Ther 17:377CrossRefGoogle Scholar