Przepiera-Bedzak Hanna
Klinika Reumatologii Pomorskiej Akademii Medycznej w Szczecinie, Szczecin.
Ann Acad Med Stetin. 2007;53(3):39-47.
Purpose of the study was: 1) to assess the best localization and the method for diagnosis of osteoporosis; 2) to assess risk factors of osteoporosis; 3) to assess risk factors of spinal fractures due to osteoporosis; 4) assessment of bone metabolism.
The study consisted of 46 male patients with confirmed diagnosis of ankylosisng spondylitis (AS) aged 23-68 years. All patients underwent the following assessment: lateral x-ray of spine, bone mineral density (BMD) assessment of lumbar spine, femoral neck and radius by DEXA method and bone mineral density assessment of radius by peripheral quantitative computed tomography (pQCT) method. Activity of bone specific alkaline phosphatase, hydroxyproline-creatinine ratio and calcium-creatinine ratio were assessed. The following indexes were assessed: BASMI, BASFI, BASDAI, BASG-t i BASG-6. Biochemical activity of the disease was assessed by C-reactive protein (CRP), mucoproteids, fibrinogen, erythrocyte sedimentation rate.
34.8% of AS patients had spinal fractures. There were 19 fractures of thoracic spine, 9 of cervical and 5 of lumbar spine. There was negative correlation of spinal fractures and neck osteopenia (r = -0.485; p = 0.05). There was increased relative risk of fractures in patients with increased BASFI, BASDAI and BASMI and with increased level of CRP. Older patients with longer history of disease had higher relative risk of fractures. Together along with the duration of disease there was the decrease of neck BMD and the increase of lumbar BMD. AS patients compared with control group had increased hydroxyproline-creatinine ratio.
Ankylosing spondylitis patients have increased risk of spinal fractures due to osteoporosis. Assessment of BMD at femoral neck is the best for assessment of osteoporosis in AS patients.
本研究的目的是：1）评估骨质疏松症的最佳定位及诊断方法；2）评估骨质疏松症的危险因素；3）评估骨质疏松症导致脊柱骨折的危险因素；4）评估骨代谢。
本研究包括46例确诊为强直性脊柱炎（AS）的男性患者，年龄在23至68岁之间。所有患者均接受了以下评估：脊柱侧位X线检查、采用双能X线吸收法（DEXA）评估腰椎、股骨颈和桡骨的骨密度，以及采用外周定量计算机断层扫描（pQCT）法评估桡骨的骨密度。评估骨特异性碱性磷酸酶活性、羟脯氨酸 - 肌酐比值和钙 - 肌酐比值。评估以下指标：BASMI、BASFI、BASDAI、BASG - t和BASG - 6。通过C反应蛋白（CRP）、粘蛋白、纤维蛋白原、红细胞沉降率评估疾病的生化活性。
34.8%的AS患者发生脊柱骨折。胸椎骨折19例，颈椎骨折9例，腰椎骨折5例。脊柱骨折与颈部骨质减少呈负相关（r = -0.485；p = 0.05）。BASFI、BASDAI和BASMI升高以及CRP水平升高的患者骨折相对风险增加。病程较长的老年患者骨折相对风险较高。随着病程的延长，颈部骨密度降低，腰椎骨密度升高。与对照组相比，AS患者的羟脯氨酸 - 肌酐比值升高。
强直性脊柱炎患者因骨质疏松症发生脊柱骨折的风险增加。评估股骨颈骨密度是评估AS患者骨质疏松症的最佳方法。
