Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Probability of the 10-year Risk of Hip and Major Osteoporotic Fracture in Non-radiographic Axial Spondyloarthritis

Author(s): Hanene Lassoued Ferjani*, Ons Boudriga, Dorra Ben Nessib, Dhia Kaffel, Kaouther Maatallah and Wafa Hamdi

Volume 20, Issue 1, 2024

Published on: 29 August, 2023

Page: [82 - 87] Pages: 6

DOI: 10.2174/1573397119666230804122659

Price: $65

Abstract

Background: Fracture risk in non-radiographic spondyloarthritis is underestimated. A reliable tool such as the Fracture Risk Assessment tool (FRAX) may assess this risk probability. This study aimed to assess the fracture risk by the FRAX score in patients with nr-axSpA and to determine factors associated with high fracture risk.

Methods: We conducted a retrospective study of nr-axSpA patients meeting the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for spondyloarthritis. All patients had Bone Mineral Density (BMD) by dual-energy X-ray absorptiometry (DEXA). The 10- year probability of major osteoporotic fracture (MOF) and hip fracture (HF) was calculated using the Fracture Risk Assessment Tool (FRAX).

Results: Among 40 patients with nr-axSpA, 27 were women (67.5%). Their mean age was 43.7 ± 12.1 years. The mean disease duration was 3.15 ± 2.7 years. Eighteen patients (45%) had osteopenia, and 12 patients (30%) had osteoporosis. The median HF FRAX was 0% [0-1.2]. The median MOF FRAX was 0.5% [0.3-1.8]. MOF FRAX was positively correlated with age (p = 0.002), disease onset age (p = 0.006), disease duration (p = 0.024), and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (p < 0.0001), and negatively correlated with daily calcium intake (p < 0.0001). HF FRAX was positively correlated with mSASSS (p < 0.0001) and negatively correlated with daily calcium intake (p = 0.005).

Conclusion: Our study confirmed the frequency of bone loss during nr-axSpA and showed that osteoporotic risk fracture was related not only to traditional risk factors for osteoporosis but also to disease-related factors.

Graphical Abstract

[1]
Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70(1): 25-31.
[http://dx.doi.org/10.1136/ard.2010.133645] [PMID: 21109520]
[2]
Lim MJ, Kang KY. A contemporary view of the diagnosis of osteoporosis in patients with axial spondyloarthritis. Front Med 2020; 7: 569449.
[http://dx.doi.org/10.3389/fmed.2020.569449] [PMID: 33363182]
[3]
Ramírez J, Nieto-González JC, Curbelo Rodríguez R, Castañeda S, Carmona L. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48(1): 44-52.
[http://dx.doi.org/10.1016/j.semarthrit.2017.12.001] [PMID: 29290311]
[4]
Dougados M, Sepriano A, Molto A, et al. Sacroiliac radiographic progression in recent onset axial spondyloarthritis: The 5-year data of the DESIR cohort. Ann Rheum Dis 2017; 76(11): 1823-8.
[http://dx.doi.org/10.1136/annrheumdis-2017-211596] [PMID: 28684556]
[5]
Henchiri I, Hamdi W, Maatallah K, et al. Assessment of fracture risk in patients with spondyloarthritis using the FRAX scores. Tunis Med 2019; 97(11): 1235-9.
[PMID: 32173824]
[6]
Richards C, Hans D, Leslie WD. Trabecular bone score (TBS) predicts fracture in ankylosing spondylitis: The manitoba BMD registry. J Clin Densitom 2020; 23(4): 543-8.
[http://dx.doi.org/10.1016/j.jocd.2020.01.003] [PMID: 32094033]
[7]
Pethő Z, Kalina E, Pap Z, et al. Characterization of bone metabolism in hungarian psoriatic arthritis patients: A case–control study. BMC Musculoskelet Disord 2021; 22(1): 70.
[http://dx.doi.org/10.1186/s12891-021-03952-z] [PMID: 33435899]
[8]
Phuan-udom R, Lektrakul N, Katchamart W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol 2018; 37(10): 2603-10.
[http://dx.doi.org/10.1007/s10067-018-4218-8] [PMID: 30039267]
[9]
Sieper J, van der Heijde D, Landewé R, et al. New criteria for inflammatory back pain in patients with chronic back pain: A real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 2009; 68(6): 784-8.
[http://dx.doi.org/10.1136/ard.2008.101501] [PMID: 19147614]
[10]
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondy-litis: The Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 1994; 21(12): 2286-91.
[PMID: 7699630]
[11]
Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: The development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21(12): 2281-5.
[PMID: 7699629]
[12]
Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994; 21(9): 1694-8.
[PMID: 7799351]
[13]
MacKay K, Mack C, Brophy S, Calin A. The bath ankylosing spondylitis radiology index (BASRI): A new, validated approach to disease assessment. Arthritis Rheum 1998; 41(12): 2263-70.
[http://dx.doi.org/10.1002/1529-0131(199812)41:12<2263::AIDART23>3.0.CO;2-I] [PMID: 9870884]
[14]
Wanders AJB, Landewé RBM, Spoorenberg A, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? Arthritis Rheum 2004; 50(8): 2622-32.
[http://dx.doi.org/10.1002/art.20446] [PMID: 15334477]
[15]
Kanis JA, Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. Osteoporos Int 1994; 4(6): 368-81.
[http://dx.doi.org/10.1007/BF01622200] [PMID: 7696835]
[16]
Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 2007; 83(982): 509-17.
[http://dx.doi.org/10.1136/pgmj.2007.057505] [PMID: 17675543]
[17]
Kanis JA, McCloskey EV, Johansson H, Oden A, Ström O, Borgström F. Development and use of FRAX® in osteoporosis. Osteoporos Int 2010; 21(S2): 407-13.
[http://dx.doi.org/10.1007/s00198-010-1253-y] [PMID: 20464374]
[18]
Wd L, Sn M, Lm LSN, Ev MHJ. Performance of FRAX in women with breast cancer initiating aromatase inhibitor therapy: A registry-based cohort study. J Am Soc Bone Miner Res 2019; 34(8): 1428-35.
[19]
Klingberg E, Lorentzon M, Mellström D, et al. Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment. Arthritis Res Ther 2012; 14(3): R108.
[http://dx.doi.org/10.1186/ar3833] [PMID: 22569245]
[20]
López-Medina C, Ramiro S, van der Heijde D, Sieper J, Dougados M, Molto A. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: A comparison by systematic literature review and metaanalysis. RMD Open 2019; 5(2): e001108.
[http://dx.doi.org/10.1136/rmdopen-2019-001108] [PMID: 31803500]
[21]
Kanis JA, Oden A, Johansson H, Borgström F, Ström O, McCloskey E. FRAX® and its applications to clinical practice. Bone 2009; 44(5): 734-43.
[http://dx.doi.org/10.1016/j.bone.2009.01.373] [PMID: 19195497]
[22]
Key TJ, Appleby PN, Spencer EA, Roddam AW, Neale RE, Allen NE. Calcium, diet and fracture risk: A prospective study of 1898 incident fractures among 34 696 British women and men. Public Health Nutr 2007; 10(11): 1314-20.
[http://dx.doi.org/10.1017/S1368980007696402] [PMID: 17381900]
[23]
Pray C, Feroz NI, Nigil Haroon N. Bone mineral density and fracture risk in ankylosing spondylitis: A meta-analysis. Calcif Tissue Int 2017; 101(2): 182-92.
[http://dx.doi.org/10.1007/s00223-017-0274-3] [PMID: 28421263]
[24]
Kang KY, Ju JH, Park SH, Hong YS. Longitudinal association between trabecular bone loss and disease activity in axial spondyloarthritis: A 4-year prospective study. J Rheumatol 2020; 47(9): 1330-7.
[http://dx.doi.org/10.3899/jrheum.190749] [PMID: 31732556]
[25]
Ulu MA, Batmaz İ, Dilek B, Çevik R. Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis. Chin Med J 2014; 127(15): 2740-7.
[PMID: 25146606]
[26]
Fauny M, Verhoeven F, Allado E, et al. Relationship between spinal structural damage on radiography and bone fragility on CT in anky-losing spondylitis patients. Sci Rep 2021; 11(1): 9342.
[http://dx.doi.org/10.1038/s41598-021-88838-9] [PMID: 33927314]
[27]
Briot K, Roux C. Inflammation, bone loss and fracture risk in spondyloarthritis: Figure 1. RMD Open 2015; 1(1): e000052.
[http://dx.doi.org/10.1136/rmdopen-2015-000052] [PMID: 26509065]
[28]
Boussoualim K, Amouzougan A, Pallot-Prades B, et al. Evaluation of bone quality with trabecular bone score in active spondyloarthritis. Joint Bone Spine 2018; 85(6): 727-31.
[http://dx.doi.org/10.1016/j.jbspin.2018.02.006] [PMID: 29631069]
[29]
Ghozlani I, Ghazi M, Nouijai A, et al. Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 2009; 44(5): 772-6.
[http://dx.doi.org/10.1016/j.bone.2008.12.028] [PMID: 19442629]
[30]
Geusens P, De Winter L, Quaden D, et al. The prevalence of vertebral fractures in spondyloarthritis: Relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma. Arthritis Res Ther 2015; 17(1): 294.
[http://dx.doi.org/10.1186/s13075-015-0809-9] [PMID: 26493218]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy