Rheumatology International

, Volume 32, Issue 9, pp 2801–2808 | Cite as

Relationship of bone mineral density with disease activity and functional ability in patients with ankylosing spondylitis: a cross-sectional study

  • Simeon Grazio
  • Zvonko Kusić
  • Selma Cvijetić
  • Frane Grubišić
  • Antonija Balenović
  • Tomislav Nemčić
  • Valentina Matijević-Mikelić
  • Marija Punda
  • Joachim Sieper
Original Article


In ankylosing spondylitis, inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis. In 80 patients with established ankylosing spondylitis, disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analog scale. BMD was measured by dual-energy X-ray absorptiometry. There was a significant negative correlation of bone density T scores with acute-phase reactants (i.e., patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine. There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly, more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (P = 0.030). Our results indicate an association of low BMD with high disease activity in patients with AS. Femoral BMD seems to be more associated with disease activity and functional ability than lumbar spine BMD.


Ankylosing spondylitis Bone mineral density Disease activity Functional ability 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Simeon Grazio
    • 1
  • Zvonko Kusić
    • 2
  • Selma Cvijetić
    • 3
  • Frane Grubišić
    • 1
  • Antonija Balenović
    • 4
  • Tomislav Nemčić
    • 1
  • Valentina Matijević-Mikelić
    • 1
  • Marija Punda
    • 2
  • Joachim Sieper
    • 5
  1. 1.University Department of Rheumatology, Physical and Rehabilitation MedicineSisters of Mercy University Hospital Centre, Referral Centre for the Spondyloarthropathies of the Ministry of Health and Social Welfare Republic of CroatiaZagrebCroatia
  2. 2.Department of Oncology and Nuclear MedicineSisters of Mercy University Hospital CentreZagrebCroatia
  3. 3.Institute for Medical Research and Occupational HealthZagrebCroatia
  4. 4.Department of RadiologyMedikol Outpatients ClinicZagrebCroatia
  5. 5.Medical Department I, RheumatologyCharité, University Medicine BerlinBerlinGermany

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