Ardizzone M, Javier R M, Kuntz J L
Service de Rhumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Rev Med Interne. 2006 May;27(5):392-9. doi: 10.1016/j.revmed.2005.09.008. Epub 2005 Oct 24.
Ankylosing Spondylitis (AS) is an inflammatory rheumatism characterized by its disease course with flares leading to progressive ankylosis of the spine related to paravertebral ligamentous and discal structures ossification. AS patients suffer significantly more vertebral fractures than control groups. These fractures could affect cervical spine. They are due to either ankylosis-related flawed spine compliance or AS-induced osteoporosis.
The physiopathology of this osteoporosis is multi-factorial, but essentially linked to AS-related inflammatory phenomenons. It is marked by reduced bone density (at lumbar spine and femoral neck), increased bone turnover (with increased urinary C-telopeptide cross-linked collagen type 1), but without any significant change in phosphocalcic blood parameters. Histological features are depressed bone formation, with either maintained or increased resorption.
The screening of this osteoporosis is based upon investigating people at risk (progressive inflammatory AS) using dual-energy x-ray absorptiometry and biochemical markers of bone turnover. Treatment is based upon a modulation of both inflammatory phenomenons and bone remodelling using bisphosphonates and anti-TNF alpha.
强直性脊柱炎（AS）是一种炎症性风湿病，其病程特点为病情发作，导致与椎旁韧带和椎间盘结构骨化相关的脊柱进行性强直。AS患者发生椎体骨折的几率明显高于对照组。这些骨折可能影响颈椎。其原因要么是与强直相关的脊柱顺应性缺陷，要么是AS引起的骨质疏松症。
这种骨质疏松症的病理生理学是多因素的，但本质上与AS相关的炎症现象有关。其特征是骨密度降低（腰椎和股骨颈）、骨转换增加（尿I型胶原C端肽交联增加），但血磷钙参数无明显变化。组织学特征是骨形成受抑制，吸收维持或增加。
这种骨质疏松症的筛查基于对高危人群（进行性炎症性AS患者）使用双能X线吸收法和骨转换生化标志物进行检测。治疗基于使用双膦酸盐和抗TNF-α对炎症现象和骨重塑进行调节。
