Skip to main content
Log in

Ankylosing spondylitis and bone mineral density—what is the ideal tool for measurement?

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript


Ankylosing spondylitis (AS) is characterised by chronic inflammation and partial ossification, yet vertebral fractures due to osteoporosis, although common, are frequently unrecognised. The aim of this study was to (1) show the frequency of changes in the progress of osteopenia/osteoporosis in AS depending on duration and stage of the disease and (2) assess the ranking of two different methods of bone density measurement in this clinical pattern. We measured bone density in 84 male and female patients with both dual X-ray absorptiometry (DXA) and single energy quantitative computed tomography (SE-QCT). In the initial and advanced stages of the disease, a high decrease in axial bone density could be verified (DXA: osteopenia in 5% and osteoporosis in 9.2%; SE-QCT: osteopenia in 11.8% and osteoporosis in 30.3%). Peripheral bone density decrease as in osteopenia could be proven in 17.6% by DXA measurement. With SE-QCT, a decrease in vertebral trabecular bone density could already be observed in the initial stage and continued steadily during the course of the disease; cortical bone displayed the same trend up to stages of ankylosis. With DXA, valid conclusions are more likely to be expected in less marked ankylosing stages of AS. In stages of advanced ankyloses in the vertebral region (substantial syndesmophytes), priority should be given to SE-QCT, due to the selective measurement of trabecular and cortical bone. The DXA method often yields values that are too high, and the replacement of vertebral trabecular bone by fatty bone marrow is not usually recorded as standard. There may already be an increased risk of bone fracture in AS in osteopenia on DXA along with an osteoporosis already established on SE-QCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Lange U, Kluge A, Teichmann J, Stracke H, Rau WS, Schmidt KL (2001) Bone density measurement by dual X ray absorptiometry (DXA) and single energy-quantitative computed tomography (SE-QCT) in ankylosing spondylitis—critical comments. Akt Rheumatol 26:1–6

    Article  Google Scholar 

  2. Donelly S, Doyle DV, Denton A et al (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53:117–121

    CAS  PubMed  Google Scholar 

  3. Kessler-Leonhardt FW, Droste U (1991) Komplikationen und Schweregrad der Stammskelett-Osteoporose bei Spondylitis ankylosans (M. Bechterew). In: Ittel TH, Sieberth H-G, Matthias S (eds) Aktuelle Aspekte der Osteologie. Springer, Berlin Heidelberg New York, pp 457–461

  4. Ralston SM, Urquhart GD, Brezeski M, Sturrock RD (1990) Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. Br Med J 300:563–565

    CAS  Google Scholar 

  5. Bröll H, Pajenda GS (2001) Das Osteoporoseproblem bei Spondylitis ankylosans. In: Schmidt KL (ed) Ankylosierende Spondylitis. Novartis, Nuremberg, pp 183–188

  6. Felsenberg D, Kalender W, Rüegsegger P (1993) Osteodensitometrische Untersuchungsverfahren—Darstellung der Methoden und Qualitätssicherungsmaßnahmen. Osteologie 3:123–138

    Google Scholar 

  7. Felsenberg D (1995) Bildgebende Verfahren und Knochendichtemessungen. In: Seibel MJ, Kraenzlin ME (eds) Osteoporose: moderne Diagnostik—therapeutische Konsequenzen für Klinik und Praxis. Karger, Basel, pp 6–12

  8. Fischer W, Kempers B, Spitz J (1990) Knochendensitometrie–Wertigkeit und Grenzen der Methode. Der Nuklearmediziner 2:77–82

    Google Scholar 

  9. Hans D, Fuerst T, Lang T, Majumdar S, Lu Y, Genant HK, Glüer C (1997) How can we measure bone quality? Baillieres Clin Rheumatol 11:495–515

    CAS  PubMed  Google Scholar 

  10. Schneider P, Börner W (1990) Indikation zur Knochendichtemessung und kritische Bewertung. Der Nuklearmediziner 2:83–91

    Google Scholar 

  11. Truscott JG, Devlin J, Emery P (1996) DXA scanning. Baillieres Clin Rheumatol 10:679–98

    CAS  PubMed  Google Scholar 

  12. Moll LMH, Wright V (1973) New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis 32:354

    CAS  PubMed  Google Scholar 

  13. Kanis JA, Melton III LJ, Christiansen C et al (1994) The diagnosis of osteoporosis. J Bone Min Res 9:1137–1141

    CAS  Google Scholar 

  14. Bhalla AK, Shenstone B (1992) Bone densitometry measurements in early inflammatory disease. Baillieres Clin Rheumatol 2:405–414

    Google Scholar 

  15. Oelzner P, Hein G (1997) Entzündung und Knochenstoffwechsel bei rheumatoider Arthritis. Med Klin 92:607–614

    CAS  PubMed  Google Scholar 

  16. Woolf AD (1992) Osteoporosis in rheumatoid arthritis—the clinical viewpoint. Br J Rheumatol 30:82

    Google Scholar 

  17. Lange U (2002) Ankylosing spondylitis and osteoporosis—an update overview. Akt Rheumatol 27:147–151

    Article  Google Scholar 

  18. Bronson WD, Walter SE, Hillmann LS, Keisler D, Hoyt T, Allen SH (1998) Bone mineral density and biochemical markers of bone metabolism in ankylosing spondylitis. J Rheumatol 25:929–935

    CAS  PubMed  Google Scholar 

  19. Fagge CH (1877) A case of simple synostosis of the ribs to the vertebrae and of the arches and articular processes of the vertebrae themselves, and also of one hip-joint. Trans Pathol Soc London 28:201

    Google Scholar 

  20. Marie P (1898) Sur la spondylose rhizomyelique. Rev Med 18:285

    Google Scholar 

  21. Schilling F (1974) Spondylitis ankylopoetica. In: Diethelm L (eds) Röntgendiagnostik der Wirbelsäule. Teil 2. Springer, Berlin Heidelberg New York, pp 452–689

  22. Schilling F (1981) Die Spondylitis ankylosans (sog. bechterewsche Krankheit)—eine aktuelle Übersicht. Immun Infekt 9:189–203

    CAS  PubMed  Google Scholar 

  23. Sivri A, Kilinc S, Gokce-Kutsal Y, Ariyurek M (1996) Bone mineral density in ankylosing spondylitis. Clin Rheumatol 15:51–54

    Google Scholar 

  24. Will R, Palmer R, Bhalla AK, Ring F, Colin A (1989) Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet II:1483–1485

    Article  Google Scholar 

  25. Schilling F (2003) Osteoporose der ankylosierenden Spondylitis in Abhängigkeit von deren Verlaufstypen. Z Rheumatol 62:492–495

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  27. Will R, Palmer R, Elvins D, Ring F, Bhalla AK (1990) A lower femoral neck BMD occurs in patients with ankylosing spondylitis compared with their normal sex siblings. In: Christiansen C, Overgaard K (eds) Osteoporosis. Handelstrykkeriet, Aalborg, pp 1672–1674

  28. Maillefert JF, Aho LS, El Maghraoui A, Dougados M, Roux C (2001) Changes in bone density in patients with ankylosing spondylitis: a two year follow up study. Osteoporosis Int 12:605–609

    Article  CAS  Google Scholar 

  29. Gratacós J, Collado A, Pons F, Osaba M, Sanmarti R, Roqué M, et al (1999) Significant loss of bone mass in patients with early active ankylosing spondylitis. Arthritis Rheum 42:2319–2324

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  31. Lange U (2001) Neue Erkenntnisse zum Knochenstoffwechsel bei ankylosierender Spondylitis. In: Schmidt KL (ed) Ankylosierende Spondylitis. Novartis, Nuremberg, pp 189–203

  32. Lange U, Teichmann J, Stracke H (2000) Correlation between plasma TNF-α, IGF-1, biochemical markers of bone metabolism, markers of inflammation/disease activity, and clinical manifestations in ankylosing spondylitis. Eur J Med Res 5:507–511

    CAS  PubMed  Google Scholar 

  33. Obermayer-Pietsch BM, Lange U, Tauber G, Fruhauf G, Fahrleitner A, Dobnig H, Hermann J, Aglas F, Teichmann J, Neeck G, Leb G (2003) Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis. Osteoporosis Int 14:995–1000

    Article  CAS  Google Scholar 

  34. Keck E, Kruse HP (1994) Osteoporose. Klinik-Diagnostik-Therapie. Erste Auflage. Fischer, Jena

  35. Szejnfeld VL, Monier-Faugere MC, Bognar BJ, Ferraz MB, Malluche HH (1997) Systemic osteopenia and mineralization defect in patients with ankylosing spondylitis. J Rheumatol 24:683–688

    CAS  PubMed  Google Scholar 

  36. Maksymovych WP, Jhangri GS, Leclercq S, Skeith K, Yan A, Russell AS (1998) An open study of pamidronate in the treatment of refractory ankylosing spondylitis. J Rheumatol 25:714–717

    PubMed  Google Scholar 

  37. Allali F, Breban M, Porcher R, Maillefert JF, Dougados M, Roux C (2003) Increase in bone mineral density of patients with spondylarthropathy treated with anti-tumour necrosis factor α. Ann Rheum Dis 63:347–349

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Uwe Lange.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: