Abstract
Objective: To assess if patients affected by systemic autoinflammatory diseases (SAIDs) present an increased risk of osteoporosis (OP).Methods: Forty adults patients referred to the Rheumatology Unit of Padova University Hospital affected by Familial Mediterranean Fever (FMF), TNF-Receptor Associated Periodic Syndrome (TRAPS), and Mevalonate Kinase Deficiency (MKD) and 40 healthy subjects were enrolled. Blood and urine samples were collected in order to define phosphocalcic metabolism, including Receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and among inflammatory markers serum amyloid A (SAA). Femur and lumbar dual-energy X-ray absorptiometry (DXA) scans were performed and Trabecular Bone Score (TBS) was calculated on DXA lumbar images.Results: We did not observe a statistically significant difference between Bone Mineral Density (BMD) and TBS of patients compared to controls. Also, the values of phosphocalcic metabolites in patients did not statistically differ from those in controls. However, SAA and OPG levels were significantly higher in patients compared to healthy subjects (p = 0.0244 and p = 0.0064, respectively).Conclusion: Patients of our cohort affected by FMF, TRAPS, and MKD do not present an increased risk of OP compared to the healthy controls. TBS and BMD are similar between the two groups underlining a preserved bone quality in patients. High OPG levels could suggest a protective role and a bone re-balancing action in response to an inflammatory background. Finally, it should be taken into account a modulatory role played by a pro-inflammatory cytokine such as SAA on bone homeostasis.
Highlights
Systemic autoinflammatory diseases (SAIDs) represent a group of disorders of the innate immune system characterized by episodes of systemic inflammation such as recurrent fever attacks with polyserositis and skin, musculo-skeletal, and articular involvement
The aims of our study are focused on the assessment of bone metabolism in patients affected by SAIDs compared to healthy subjects, and on the relationship between bone turnover markers (BTM), and inflammatory marker (SAA)
No differences were observed in terms of sex, Body Mass Index (BMI), family history of fractures, prior fragility fractures, and common habits
Summary
Systemic autoinflammatory diseases (SAIDs) represent a group of disorders of the innate immune system characterized by episodes of systemic inflammation such as recurrent fever attacks with polyserositis and skin, musculo-skeletal, and articular involvement. In the present work we included adult patients affected by hereditary periodic fevers, in Osteoporosis in SAIDs particular patients with Familial Mediterranean Fever (FMF), TNF Receptor Associated Periodic Syndrome (TRAPS), and Mevalonate Kinase Deficiency (MKD) [2]. Different studies show that chronic inflammation, perpetuated by pro-inflammatory cytokines, may exert a role on bone metabolism, eventually leading to osteoporosis (OP) onset [3,4,5]. The aims of our study are focused on the assessment of bone metabolism in patients affected by SAIDs compared to healthy subjects, and on the relationship between bone turnover markers (BTM) (receptor activator of nuclear factor kappa-B ligand, RANKL, and osteoprotegerin, OPG), and inflammatory marker (SAA)
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