Bone mass in axial spondyloarthritis: A literature review

Abstract

AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis (SpA)particularly those studies using dual X-ray absorptiometry(DXA) methods.METHODS: This literature review examines thereported bone mass in patients with ax-SpA, particularlythose using the DXA methods. The MEDLINE, Webof Science and Scopus databases were searched forrelevant articles published between September 1992and November 2013. Some of used search terms wereankylosing spondylitis (AS), SpA, spondyloarthropathy,bone loss, bone mass, osteopenia, bone mineral density, osteoporosis (OP), densitometry. Studiesin which bone loss was investigated by using DXAin patients with SpA were eligible. Each article wasreviewed and the key elements were noted.RESULTS: There were 286 hits on MEDLINE, 200 onWeb of Science and 476 on Scopus. After applyinginclusion and exclusion criteria, we identified 55 articlesin our systematic search. The sample size of the studiesvaried from 14 to 332 patients with SpA. The reportedage range varied from 25 to 56 years in the reviewedstudies. The symptom duration of patients with axSpAvaried from 1.6 to 49 years. There were more malesthan females in these studies. Most of the recruitedfemales were premenopausal women. ReportedHLA-B27 positivity changed between 19% to 95%.The prevalence of OP and osteopenia in patients withSpA varied from 3%-47% to 5%-88%, respectively,in the included studies. In particular, the prevalenceof OP and osteopenia ranged from 2.0%-47.0% and5.0%-78.3%, respectively, in patients with AS. Thereare conflicting results regarding the relationship amongdisease activity, acute phase response and bone mass.Some studies suggest good correlation of bone masswith disease activity and acute phase reactants.CONCLUSION: Bone loss may be determined inpatients with axSpA at the lumbar spine or proximalfemur even in the early phase of the disease and maybe associated with inflammation (bone marrow edema)at the vertebral colon