Abstract

ObjectiveThis study aimed to assess the relationship between bone marrow edema (BME) on magnetic resonance imaging (MRI) and bone mineral density (BMD) in patients with ankylosing spondylitis (AS).MethodsThe study included 333 patients with AS who underwent BMD measurements and axial MRI. Additionally, 106 normal controls were included. The modified New York criteria were used as the classification criteria of AS. Clinical, laboratory, and imaging data were collected and analyzed. Lumbar spine and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Low BMD was defined by a Z-score ≤-2. The Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index was used to assess inflammation at the sacroiliac joint (SIJ) and spine.ResultsAmong the 333 patients, the male:female ratio was 4.6:1, mean patient age was 28.5±10.6 years, and mean disease duration was 7.3±6.8 years. The prevalences of low BMD, osteopenia, and osteoporosis were significantly higher among AS patients than among controls (19.8%, 62.8%, and 5.7% vs. 4.7%, 33.0%, and 0%, respectively, P = 0.000). The BMD values were significantly lower and prevalences of low BMD at both the spine and femur were significantly higher among patients with BME on MRI than among those without BME. Multivariate logistic regression analysis showed that male sex (OR 3.87, 95% CI 1.21–7.36, P = 0.023), high ASDAS-CRP score (OR 2.83, 95% CI 1.36–4.76, P = 0.015), the presence of BME on sacroiliac MRI (OR 2.83, 95% CI 1.77–6.23, P = 0.000) and spinal MRI (OR 4.06, 95% CI 1.96–8.46, P = 0.000), and high grade of sacroiliitis (OR 2.93, 95% CI 1.82–4.45, P = 0.002) were risk factors for low BMD (any site). The SPARCC scores of the SIJ were negatively correlated with femoral BMD (r = -0.22, 95% CI -0.33 to -0.10, P = 0.000). Additionally, the SPARCC scores of the spine were negatively correlated with BMD values (r = -0.23, 95% CI -0.36 to -0.09, P = 0.003) and Z-scores (r = -0.24, 95% CI -0.36 to -0.12, P = 0.001) at the spine.ConclusionLow BMD is common in AS patients. BME on MRI is highly associated with low BMD at both the spine and femur.

Highlights

  • Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease mainly characterized by inflammation of the axial joints

  • Multivariate logistic regression analysis showed that male sex, high ankylosing spondylitis disease activity score (ASDAS)-C-reactive protein (CRP) score, the presence of bone marrow edema (BME) on sacroiliac magnetic resonance imaging (MRI) and spinal MRI, and high grade of sacroiliitis were risk factors for low bone mineral density (BMD)

  • The Spondyloarthritis Research Consortium of Canada (SPARCC) scores of the sacroiliac joint (SIJ) were negatively correlated with femoral BMD (r = -0.22, 95% CI -0.33 to -0.10, P = 0.000)

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Summary

Introduction

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease mainly characterized by inflammation of the axial joints. Osteoporosis (OP) is commonly seen in AS patients, even in the early stage of the disease [1,2,3,4,5], and is associated with an increased risk of fracture. In AS patients, spinal and sacroiliac joint (SIJ) magnetic resonance imaging (MRI) is being used to assess inflammation as an indicator of disease activity [8,9]. Lesions of active inflammation on MRI are depicted as areas of increased signal intensity on T2-weighted images with fat saturation short τ inversion recovery sequences and described as bone marrow edema (BME) [10]. Histopathological studies conducted in both AS and rheumatoid arthritis patients have verified that BME on MRI reflects bone inflammation [11,12,13]. There has been no large cohort study on the relationship between BME on MRI and bone loss in AS patients

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