A Contemporary View of the Diagnosis of Osteoporosis in Patients With Axial Spondyloarthritis.

Mie Jin Lim,Kwi Young Kang

doi:10.3389/fmed.2020.569449

Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the axial joints. Altered bone metabolism associated with chronic inflammation leads to both new bone formation in the spine and increased bone loss. It is known that patients with axSpA have a high prevalence of osteoporosis and fractures. However, there is no consensus on which imaging modality is the most appropriate for diagnosing osteoporosis in axSpA. Bone mineral density measurement using dual-energy X-ray absorptiometry is the primary diagnostic method for osteoporosis, but it has notable limitations in patients with axSpA. This method may lead to the overestimation of bone density in patients with axSpA because they often exhibit abnormal calcification of spinal ligaments or syndesmophytes. Therefore, the method may not provide adequate information about bone microarchitecture. These limitations result in the underdiagnosis of osteoporosis. Recently, new imaging techniques, such as high-resolution peripheral quantitative computed tomography, and trabecular bone score have been introduced for the evaluation of osteoporosis risk in patients with axSpA. In this review, we summarize the current knowledge regarding imaging techniques for diagnosing osteoporosis in patients with axSpA.

Highlights

Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture caused by minimal or low trauma
An increasing body of evidence indicates that current approaches for diagnosing osteoporosis are insufficient, and new methods are required to account for the different characteristics of chronic inflammatory arthritis
In a cross-sectional study of 255 patients with Axial spondyloarthritis (axSpA), we found that low trabecular bone score (TBS) was associated with prevalent vertebral fracture, whereas lumbar spine bone mineral density (BMD) was not and that TBS showed better discriminatory values for prevalent vertebral fracture than total hip BMD [67]

Summary

Introduction

Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture caused by minimal or low trauma. Increased fracture risk in axSpA patients is likely to be multifactorial, resulting from traditional osteoporosis risk factors and additional disease-related factors such as systemic inflammation, which affect BMD and bone quality [12, 13]. A high frequency of vertebral fractures in patients with early spondyloarthritis (SpA) was associated with low BMD of the lumbar spine [38].

Results

Conclusion