Advertisement

Rheumatology International

, 30:375 | Cite as

The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis

  • Bedriye Mermerci Başkan
  • Yasemin Pekin Doğan
  • Filiz Sivas
  • Hatice Bodur
  • Kürşat Özoran
Original Article

Abstract

In this study, the relation between osteoporosis and vitamin D and the disease activity in patients with ankylosing spondylitis (AS) was investigated. A hundred patients with AS and 58 healthy individuals were included in the study. In addition to the routine blood and urine tests, serum 25-(OH)D3, parathormone (PTH), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total calcium, ionized calcium, and phosphorous levels of all participants were also measured. Bone mineral density (BMD) measurements were performed at the anterior–posterior and lateral lumbar and femur regions. Anterior–posterior and lateral thoracic and lumbosacral radiography was performed on all participants. The disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional status by Bath Ankylosing Spondylitis Functional Index (BASFI), and mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI). In the patient group, BMD values obtained from the lateral lumbar and femur regions and serum vitamin D levels were lower than the control group. A negative relation was determined between the lateral lumbar BMD values and ESR, CRP, and BASDAI scores of patients with AS. The ESR, CRP levels, and BASMI scores of the AS patients with osteoporosis were significantly higher, when compared to patients without osteoporosis. The negative correlation between serum 25-(OH)D3 level and ESR, CRP levels did not reach a statistically significant level in patients with AS; the positive correlation between PTH levels and ESR, and the negative correlation between CRP and BASDAI also did not reach a statistically significant level. Vitamin D deficiency in AS may indirectly lead to osteoporosis by causing an increase in the inflammatory activity. The present authors believe that it would be beneficial to monitorize vitamin D levels together with BMD measurements in order to determine the patients under osteoporosis risk.

Keywords

Ankylosing spondylitis Osteoporosis Vitamin D Inflammatory activity 

Notes

Conflict of interest

There is no conflict of interest regarding financial or other relationships.

References

  1. 1.
    Van Der Linden S, Van Der Hejide D, Braun J (2005) Ankylosing spondylitis. In: Harris ED, Budd RC, Frestein GS et al (eds) Kelley’s textbook of rheumatology. Elsevier Saunders,  Philadelphia, PA, pp 1125–1141Google Scholar
  2. 2.
    Will R, Palmer R, Bhalla AK et al (1989) Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet 2(8678–8679):1483–1485CrossRefPubMedGoogle Scholar
  3. 3.
    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):2319–2324CrossRefPubMedGoogle Scholar
  4. 4.
    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):1999–2004CrossRefPubMedGoogle Scholar
  5. 5.
    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):1031–1035CrossRefPubMedGoogle Scholar
  6. 6.
    Manolagas SC (1995) Role of cytokines in bone resorption. Bone 17(2 Suppl):63S–67SCrossRefPubMedGoogle Scholar
  7. 7.
    Pacifici R (1995) Cytokines and osteoclast activity. Calcif Tissue Int 56(Suppl 1):S27–S28PubMedGoogle Scholar
  8. 8.
    Nguyen L, Dewhirst FE, Hauschka PV et al (1991) Interleukin-1 beta stimulates bone resorption and inhibits bone formation in vivo. Lymphokine Cytokine Res 10(1–2):15–21PubMedGoogle Scholar
  9. 9.
    Fujita T, Matsui T, Nakao Y et al (1990) Cytokines and osteoporosis. Ann N Y Acad Sci 587:371–375PubMedGoogle Scholar
  10. 10.
    Baier R, Grauer A, Lazaretti-Castro M et al (1994) Differential effects of 1, 25-dihydroxyvitamin D3 on cell proliferation and calcitonin gene expression. Endocrinology 135(5):2006–2011CrossRefPubMedGoogle Scholar
  11. 11.
    Muller K, Bendtzen K (1996) 1,25-Dihydroxyvitamin D3 as a natural regulator of human immune functions. J Investig Dermatol Symp Proc 1(1):68–71PubMedGoogle Scholar
  12. 12.
    Amento EP (1987) Vitamin D and the immune system. Steroids 49(1–3):55–72CrossRefPubMedGoogle Scholar
  13. 13.
    Bouillon R, Okamura WH, Norman AW (1995) Structure-function relationships in the vitamin D endocrine system. Endocr Rev 16(2):200–257PubMedGoogle Scholar
  14. 14.
    Cantorna MT, Mahon BD (2005) D-hormone and the immune system. J Rheumatol Suppl 76:11–20PubMedGoogle Scholar
  15. 15.
    Deluca HF, Cantorna MT (2001) Vitamin D: its role and uses in immunology. Faseb J 15(14):2579–2585CrossRefPubMedGoogle Scholar
  16. 16.
    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):361–368CrossRefPubMedGoogle Scholar
  17. 17.
    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):2286–2291PubMedGoogle Scholar
  18. 18.
    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):2281–2285PubMedGoogle Scholar
  19. 19.
    Yanik B, Gursel YK, Kutlay S et al (2005) Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 24(1):41–47CrossRefPubMedGoogle Scholar
  20. 20.
    Ay S, Kutlay Ş, Kurtaiş Y (2004) Ankilozan Spondilitli Hastalarda Bath Ankilozan Spondilit Hastalık Aktivite İndeksinin (BASHAİ) Türkçe Versiyonunun Geçerlilik Ve Güvenirlik Çalışması. Romatizma (Acta Rheumatol Turcica) 19(3):139–146Google Scholar
  21. 21.
    Jenkinson TR, Mallorie PA, Whitelock HC et al (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 21(9):1694–1698PubMedGoogle Scholar
  22. 22.
    Melton LJIII, Lane AW, Cooper C et al (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3(3):113–119CrossRefPubMedGoogle Scholar
  23. 23.
    Ozoran K, Paker N, Basgoze O et al (1989) Calcitonin and calcium combined therapy in osteoporosis: effects on vertebra trabecular bone density. J Int Med Res 17(4):395–400PubMedGoogle Scholar
  24. 24.
    El Maghraoui A, Borderie D, Cherruau B et al (1999) Osteoporosis, body composition, and bone turnover in ankylosing spondylitis. J Rheumatol 26(10):2205–2209PubMedGoogle Scholar
  25. 25.
    Ralston SH, Urquhart GD, Brzeski M et al (1990) Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. BMJ 300(6724):563–565CrossRefPubMedGoogle Scholar
  26. 26.
    Mullaji AB, Upadhyay SS, Ho EK (1994) Bone mineral density in ankylosing spondylitis DEXA comparison of control subjects with mild and advanced cases. J Bone Joint Surg Br 76(4):660–665PubMedGoogle Scholar
  27. 27.
    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):115–120CrossRefPubMedGoogle Scholar
  28. 28.
    Hanson CA, Shagrin JW, Duncan H (1971) Vertebral osteoporosis in ankylosing spondylitis. Clin Orthop Relat Res 74:59–64CrossRefPubMedGoogle Scholar
  29. 29.
    Cooper C, Carbone L, Michet CJ et al (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21(10):1877–1882PubMedGoogle Scholar
  30. 30.
    Donnelly S, Doyle DV, Denton A et al (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53(2):117–121CrossRefPubMedGoogle Scholar
  31. 31.
    Gratacos J, Collado A, Filella X et al (1994) Serum cytokines (IL-6, TNF-alpha, IL-1 beta and IFN-gamma) in ankylosing spondylitis: a close correlation between serum IL-6 and disease activity and severity. Br J Rheumatol 33(10):927–931CrossRefPubMedGoogle Scholar
  32. 32.
    El Maghraoui A (2004) Osteoporosis and ankylosing spondylitis. Joint Bone Spine 71(4):291–295CrossRefPubMedGoogle Scholar
  33. 33.
    Meirelles ES, Borelli A, Camargo OP (1999) Influence of disease activity and chronicity on ankylosing spondylitis bone mass loss. Clin Rheumatol 18(5):364–368CrossRefPubMedGoogle Scholar
  34. 34.
    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):2236–2241PubMedGoogle Scholar
  35. 35.
    Saino H, Matsuyama T, Takada J et al (1997) Long-term treatment of indomethacin reduces vertebral bone mass and strength in ovariectomized rats. J Bone Miner Res 12(11):1844–1850CrossRefPubMedGoogle Scholar
  36. 36.
    Jiang Y, Zhao J, Genant HK et al (1998) Bone mineral density and biomechanical properties of spine and femur of ovariectomized rats treated with naproxen. Bone 22(5):509–514CrossRefPubMedGoogle Scholar
  37. 37.
    Devogelaer JP, Maldague B, Malghem J, Nagant de Deuxchaisnes C (1992) Appendicular and vertebral bone mass in ankylosing spondylitis. A comparison of plain radiographs with single- and dual-photon absorptiometry and with quantitative computed tomography. Arthritis Rheum 35(9):1062–1067CrossRefPubMedGoogle Scholar
  38. 38.
    Reid DM, Nicoll JJ, Kennedy NS et al (1986) Bone mass in ankylosing spondylitis. J Rheumatol 13(5):932–935PubMedGoogle Scholar
  39. 39.
    Masud T, Langley S, Wiltshire P et al (1993) Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ 307(6897):172–173CrossRefPubMedGoogle Scholar
  40. 40.
    Bronson WD, Walker SE, Hillman LS et al (1998) Bone mineral density and biochemical markers of bone metabolism in ankylosing spondylitis. J Rheumatol 25(5):929–935PubMedGoogle Scholar
  41. 41.
    Gilgil E, Kacar C, Tuncer T et al (2005) The association of syndesmophytes with vertebral bone mineral density in patients with ankylosing spondylitis. J Rheumatol 32(2):292–294PubMedGoogle Scholar
  42. 42.
    Bessant R, Keat A (2002) How should clinicians manage osteoporosis in ankylosing spondylitis? J Rheumatol 29(7):1511–1519PubMedGoogle Scholar
  43. 43.
    Selby P (2008) Rickets and osteomalacia. In: Hochberg MC (ed) Rheumatology. Mosby Elsevier, Amsterdam, pp 1977–1987Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Bedriye Mermerci Başkan
    • 1
  • Yasemin Pekin Doğan
    • 1
  • Filiz Sivas
    • 1
  • Hatice Bodur
    • 1
  • Kürşat Özoran
    • 1
  1. 1.Department of Physical Therapy and RehabilitationAnkara Numune Education and Research HospitalAnkaraTurkey

Personalised recommendations