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Bone turnover markers, anterior pituitary and gonadal hormones, and bone mass evaluation using quantitative computed tomography in ankylosing spondylitis

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Abstract

The objective of this study was to determine bone mineral density (BMD) distribution in ankylosing spondylitis (AS) using quantitative computed tomography (QCT), to study bone turnover and anterior pituitary and gonadal hormonal axis in AS, and to look for correlations between BMD, bone remodeling markers and gonadal and anterior pituitary hormones. Forty-three male consecutive patients with AS were enrolled prospectively [mean (SD) age of 36.4 (11.3) years (range: 17–67) and mean disease duration of 6.8 (5.2) years (range: 0.4–19)]. Spine BMD was measured in all patients by QCT, and the results were compared to 29 male patients undergoing lumbar CT scan for sciatica. Bone turnover and anterior pituitary and gonadal axis were assessed in 29 patients, and the results were compared to 30 male healthy blood donors. The mean (SD) BMD was 127.7 mg/cm3 (48.9) (range: 8.8–265.7) and 152.1 (25.3) (range: 34.2–190.4) in patients and controls, respectively (p=0.018). Patients had lower serum levels of osteocalcin and higher levels of serum testosterone, luteinizing hormone (LH), and prolactin than controls with a significant statistical difference. There was a positive significant statistical correlation between BMD and chest expansion, Schober’s test, C7-wall distance, and negative significant statistical correlation with age, disease duration, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), and serum prolactin. No correlation was observed between bone turnover parameters and AS symptomatic and structural severity indexes. BMD is lower with increasing age and late and severe disease. Decreased bone formation with normal resorption and increased levels of serum prolactin may be involved in its pathophysiology.

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References

  1. Calin A, Taurog J (1998) Spondylarthritides. Oxford University Press, New York, pp 1–347

  2. van der Linden SJ, van der Heijde D (1998) Ankylosing spondylitis. Rheum Dis Clin North Am 24:663–915

    PubMed  Google Scholar 

  3. Yu D (2000) Spondylarthropathies. In: Ruddy S, Harris ED, Sledge CB (eds) Kelley’s textbook of rheumatology, 6th edn. W.B. Saunders, Philadelphia, pp 1039–1053

    Google Scholar 

  4. Khan MA (ed) (1992) Spondyloarthropathies. W.B. Saunders, Philadelphia

  5. El Maghraoui A, Bensabbah R, Bahiri R, Bezza A, Guédira N, Hajjaj-Hassouni N (2003) Cervical spine involvement in ankylosing spondylitis. Clin Rheumatol 22:94–98

    PubMed  Google Scholar 

  6. El Maghraoui A, Chaouir S, Tabache F, Abouzahir A, Bezza A, Ghafir D, Ohayon V, Archane MI (2003) High resolution thoracic CT in ankylosing spondylitis. Ann Rheum Dis 62:185–186

    CAS  PubMed  Google Scholar 

  7. Bezza A, El Maghraoui A, Ghadouane M, Tabache F, Abouzahir A, Abbar M, Ghafir D, Ohayon V, Archane MI (2002) Idiopathic retroperitoneal fibrosis and ankylosing spondylitis. A new case report. Joint Bone Spine 69:502–505

    CAS  PubMed  Google Scholar 

  8. Will R, Palmer R, Bhalla AK, Ring F, Calin A (1989) Osteoporosis in early ankylosing spondylitis. A primary pathological event? Lancet 2:1483–1485

    Article  CAS  PubMed  Google Scholar 

  9. Hansen CA, Shagrin JW, Duncan H (1971) Vertebral osteoporosis in ankylosing spondylitis. Clin Orthop 74:59–64

    PubMed  Google Scholar 

  10. Raltson SH, Urquhart GDK, Bzeski M, Sturrock RD (1990) Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis. Br Med J 300:563–565

    CAS  Google Scholar 

  11. Lee YSL, Schlotzhauer T, Ott SM, van Vollenhoven RF, Hunter J, Shapiro J, Marcus R, McGuire JL (1997) Skeletal status of men with early and late ankylosing spondylitis. Am J Med 103:233–241

    Article  CAS  PubMed  Google Scholar 

  12. Donnelly S, Doyle DV, Denton A, Rolfe J, McCloskey EV, Spector TD (1994) Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 53:117–121

    CAS  PubMed  Google Scholar 

  13. Cooper C, Carbone L, Michet CJ, Atkinson EJ, O’Fallon WM, Melton LJ (1994) Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 21:1877–1882

    CAS  PubMed  Google Scholar 

  14. Khan MA, Lai J-H, Chang D-M, Liu H-C (1993) Recognizing and managing fractures in ankylosing spondylitis. J Musculoskelet Med 1:45–57

    Google Scholar 

  15. Fox MW, Onofrio BM, Kilgore JE (1993) Neurological complications of ankylosing spondylitis. J Neurosurg 78:871–878

    CAS  PubMed  Google Scholar 

  16. Lehtilen K (1993) Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis 52:174–176

    PubMed  Google Scholar 

  17. Devogelaer J-P, Maldague B, Malghem J, Nagant de Deuxchaisnes C (1992) Appendicular and vertebral bone mass in ankylosing spondylitis. Arthritis Rheum 35:1062–1067

    CAS  PubMed  Google Scholar 

  18. El Maghraoui A (2004) Osteoporosis and ankylosing spondylitis. Bone Joint Spine 71:573–578

    Google Scholar 

  19. 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 4:361–368

    Google Scholar 

  20. Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis. The Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 21:1694–1698

    CAS  PubMed  Google Scholar 

  21. Calin A, Garrett S, Whitelock HC et al (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285

    CAS  PubMed  Google Scholar 

  22. Garrett SL, Jenkinson T, Kennedy LG, Whitelock HC, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291

    CAS  PubMed  Google Scholar 

  23. Bennet PH, Burch TA (1967) New York symposium on population studies in the rheumatic diseases: new diagnostic criteria. Bull Rheum Dis 28:453–458

    Google Scholar 

  24. MacKay K, Brophy S, Mack C, Doran M, Calin A (2000) The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol 27:2866–2872

    Google Scholar 

  25. MacKay K, Mack C, Brophy S, Calin A (1998) The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 41:2263–2270

    Article  CAS  PubMed  Google Scholar 

  26. Lang TF, Li J, Harris ST, Genant HK (1999) Assessment of vertebral bone mineral density using volumetric quantitative CT. J Comput Assist Tomogr 23:130–137

    Article  CAS  PubMed  Google Scholar 

  27. El Maghraoui A, Borderie D, Edouard R, Roux C, Dougados M (1999) Osteoporosis, body composition and bone turnover in ankylosing spondylitis. J Rheumatol 26:2205–2209

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  29. Gratacos J, Collado A, Pons F, Osaba M, Sanmarti R, Roqué M, Larroza M, Munoz-Gomez J (1999) Significant loss of bone mass in patient with early, active ankylosing spondylitis. A follow-up study. Arthritis Rheum 42:2319–2324

    Article  PubMed  Google Scholar 

  30. Marhoffer W, Stracke H, Masoud H et al (1995) Evidence of impaired cartilage/bone turnover in patients with active ankylosing spondylitis. Ann Rheum Dis 54:556–559

    CAS  PubMed  Google Scholar 

  31. MacDonald AG, Birkinshaw G, Durham B, Bucknall RC, Fraser WD (1997) Biochemical markers of bone turnover in seronegative spondylarthropathy: relationship to disease activity. Br J Rheumatol 36:50–53

    CAS  PubMed  Google Scholar 

  32. Brandt J, Frederiksen JK, Jensen CH, Teisner B (2001) The N– and C-telopeptides of human procollagen type I (PINP and PICP): molecular heterogeneity and assay technology. In: Eastell R, Baumann M, Hoyle NR, Wieczorek L (eds) Bone markers. Biochemical and clinical perspectives. Martin Dunitz, London, pp 73–82

  33. Yilmaz N, Ozaslan J (2000) Biochemical bone turnover markers in patients with ankylosing spondylitis. Clin Rheumatol 19:92–98

    CAS  PubMed  Google Scholar 

  34. Gough A, Lilley J, Eyre S, Holder RL, Emery P (1994) Generalized bone loss in patients with early rheumatoid arthritis. Lancet 344:23–27

    CAS  PubMed  Google Scholar 

  35. Laan RFJM, Buijs WCAM, Verbeek ACM et al (1993) Bone mineral density in patients with recent onset rheumatoid arthritis: influence of disease activity and functional capacity. Ann Rheum Dis 52:21–26

    CAS  PubMed  Google Scholar 

  36. Armour KE, Van’T Hof RJ, Grabowski PS, Reid DM, Ralston SH (1999) Evidence for a pathogenic role of nitric oxide in inflammation-induced osteoporosis. J Bone Miner Res 14:2137–2142

    CAS  PubMed  Google Scholar 

  37. Szeijfeld VL, Moniier-Faugere MC, Bognar BJ, Ferraz MB, Malluche BJ (1997) Systemic osteopenia and mineralization defect in ankylosing spondylitis. J Rheumatol 24:683–688

    CAS  PubMed  Google Scholar 

  38. El Maghraoui A, Dougados M, Freneaux E, Chaussade S, Amor B, Breban M (1999) Concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime-labelled leucocytes and ileocolonoscopy in patients with spondyloarthropathies and without clinical evidence of inflammatory bowel disease. Rheumatology 38:543–546

    CAS  PubMed  Google Scholar 

  39. Gooren LJ, Giltay EJ, van Schaardenburg D, Dijkmans BA (2000) Gonadal and adrenal sex steroids in ankylosing spondylitis. Rheum Dis Clin North Am 26:969–987

    CAS  PubMed  Google Scholar 

  40. Mitra D, Elvins DM, Collins AJ (1999) Testosterone and testosterone free index in mild ankylosing spondylitis: relationship with bone mineral density and vertebral fractures. J Rheumatol 26:2414–2417

    CAS  PubMed  Google Scholar 

  41. Straub RH, Struharova S, Scholmerich J, Harle P (2002) No alterations of serum levels of adrenal and gonadal hormones in patients with ankylosing spondylitis. Clin Exp Rheumatol 20 [6 Suppl 28]:S52–S59

    CAS  PubMed  Google Scholar 

  42. Giltay EJ, Popp-Snijders C, van Schaardenburg D, Dekker-Saeys BJ, Gooren LJ, Dijkmans BA (1998) Serum testosterone levels are not elevated in patients with ankylosing spondylitis. J Rheumatol 25:2389–2394

    CAS  PubMed  Google Scholar 

  43. Giltay EJ, van Schaardenburg D, Gooren LJ, Popp-Snijders C, Dijkmans BA (1999) Androgens and ankylosing spondylitis: a role in the pathogenesis? Ann N Y Acad Sci 876:340–364

    CAS  PubMed  Google Scholar 

  44. Giltay EJ, Popp-Snijders C, van Denderen JC, van Schaardenburg D, Gooren LJ, Dijkmans BA (2000) Phenylbutazone can spuriously elevate unextracted testosterone assay results in patients with ankylosing spondylitis. J Clin Endocrinol Metab 85:4923–4924

    CAS  Google Scholar 

  45. Tapia-Serrano R, Jimenez-Balderas FJ, Murrieta S, Bravo-Gatica C, Guerra R, Mintz G (1991) Testicular function in active ankylosing spondylitis. Therapeutic response to human chorionic gonadotrophin. J Rheumatol 18:841–848

    CAS  PubMed  Google Scholar 

  46. Jara LJ, Silveira LH, Cuellar ML, Pineda CJ, Scopelitis E, Espinoza LR (1994) Hyperprolactinemia in Reiter’s syndrome. J Rheumatol 21:1292–1297

    CAS  PubMed  Google Scholar 

  47. Spangelo BL, Judd AM, Isakson PC, MacLeod RM (1989) Interleukin-6 stimulates anterior pituitary hormone release in vitro. Endocrinology 125:575–577

    CAS  PubMed  Google Scholar 

  48. el Halawani ME, Youngren OM, Silsby JL, Phillips RE (1988) Involvement of serotonin in prolactin release induced by electrical stimulation of the hypothalamus of the turkey (Meleagris gallopavo). Gen Comp Endocrinol 72:323–328

    CAS  PubMed  Google Scholar 

  49. Willoughby JO, Menadue MF, Liebelt HJ (1988) Activation of 5-HT 1 serotonin receptors in the medial basal hypothalamus stimulates prolactin secretion in the unanaesthetized rat. Neuroendocrinology 47:83–87

    CAS  PubMed  Google Scholar 

  50. Pavasuthipaisit K, Norman RL, Spies HG (1980) Evidence that serotonin is involved in prolactin release by electrical stimulation of the medial basal hypothalamus in the rhesus monkey. Neuroendocrinology 31:256–260

    CAS  PubMed  Google Scholar 

  51. Athreya BH, Rafferty JH, Sehgal GS, Lahita RG (1993) Adenohypophyseal and sex hormones in pediatric rheumatic diseases. J Rheumatol 20:725–730

    CAS  PubMed  Google Scholar 

  52. Pauzner R, Urowitz MB, Gladman DD, Gough JM (1994) Prolactin in systemic lupus erythematosus. J Rheumatol 21:2064–2067

    CAS  PubMed  Google Scholar 

  53. Ostendorf B, Fischer R, Santen R, Schmitz-Linneweber B, Specker C, Schneider M (1996) Hyperprolactinemia in systemic lupus erythematosus? Scand J Rheumatol 25:97–102

    CAS  PubMed  Google Scholar 

  54. Buskila D, Lorber M, Neumann L, Flusser D, Shoenfeld Y (1996) No correlation between prolactin levels and clinical activity in patients with systemic lupus erythematosus. J Rheumatol 23:629–632

    CAS  PubMed  Google Scholar 

  55. Neidhart M (1996) Elevated serum prolactin or elevated prolactin/cortisol ratio are associated with autoimmune processes in systemic lupus erythematosus and other connective tissue diseases. J Rheumatol 23:476–481

    CAS  PubMed  Google Scholar 

  56. Blanco-Favela F, Quintal-Alvarez G, Leanos-Miranda A (1999) Association between prolactin and disease activity in systemic lupus erythematosus. Influence of statistical power. J Rheumatol 26:55–59

    CAS  PubMed  Google Scholar 

  57. McMurray RW, Weidensaul D, Allen SH, Walker SE (1995) Efficacy of bromocriptine in an open label therapeutic trial for systemic lupus erythematosus. J Rheumatol 22:2084–2091

    CAS  PubMed  Google Scholar 

  58. Blank M, Krause I, Buskila D et al (1995) Bromocriptine immunomodulation of experimental SLE and primary antiphospholipid syndrome via induction of nonspecific T suppressor cells. Cell Immunol 162:114–122

    CAS  PubMed  Google Scholar 

  59. Figueroa FE, Carrion F, Martinez ME, Rivero S, Mamani I (1997) Bromocriptine induces immunological changes related to disease parameters in rheumatoid arthritis. Br J Rheumatol 36:1022–1023

    CAS  PubMed  Google Scholar 

  60. Alvarez-Nemegyei J, Cobarrubias-Cobos A, Escalante-Triay F, Sosa-Munoz J, Miranda JM, Jara LJ (1998) Bromocriptine in systemic lupus erythematosus: a double-blind, randomized, placebo-controlled study. Lupus 7:414–419

    CAS  PubMed  Google Scholar 

  61. Eulry F, Mayaudon H, Bauduceau B, Lechevalier D, Crozes P, Magnin J, Claude-Berthelot C (1996) Prolactine sérique sous l’effet de la protireline au cours des spondylarthropathies. Essai de traitement de 4 cas d’arthrite réactionnelle et 2 cas de rhumatisme psoriasique par la bromocriptine. Ann Med Interne (Paris) 147:15–19

    CAS  Google Scholar 

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Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Military Hospital Mohammed V, Rabat, Morocco

    Abdellah El Maghraoui, Ahmed Bezza, Abderrazak Nouijai & Lahsen Achemlal

  2. Biochemistry Department, Military Hospital Mohammed V, Rabat, Morocco

    Saida Tellal, Sanaa Bouhssain & El Mostapha Derouiche

  3. Radiology Department, Military Hospital Mohammed V, Rabat, Morocco

    Souad Chaouir & Khalil Lebbar

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  1. Abdellah El Maghraoui
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  2. Saida Tellal
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  3. Souad Chaouir
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Correspondence to Abdellah El Maghraoui.

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El Maghraoui, A., Tellal, S., Chaouir, S. et al. Bone turnover markers, anterior pituitary and gonadal hormones, and bone mass evaluation using quantitative computed tomography in ankylosing spondylitis. Clin Rheumatol 24, 346–351 (2005). https://doi.org/10.1007/s10067-004-1039-8

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