Department of Rheumatology and Inflammation Research and the Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Rheumatol. 2012 Oct;39(10):1987-95. doi: 10.3899/jrheum.120316. Epub 2012 Aug 15.
To study the prevalence and risk factors for vertebral fractures (VF) in ankylosing spondylitis (AS) and the relation between VF, measures of disease activity, and bone mineral density (BMD) in different measurement sites.
Patients with AS (modified New York criteria) underwent examination, answered questionnaires, and gave blood samples. Lateral spine radiographs were scored for VF (Genant score) and syndesmophyte formation through modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). BMD was measured with dual-energy x-ray absorptiometry in the hip, radius, and lumbar spine in anteroposterior and lateral projections with estimation of volumetric BMD (vBMD).
Two hundred four patients (57% men) with a mean age of 50 ± 13 years and disease duration 15 ± 11 years were included. VF were diagnosed in 24 patients (12%), but were previously noted clinically in only 3 of the 24. Patients with VF were significantly older (p = 0.004), had longer disease duration (p = 0.011), higher Bath Ankylosing Spondylitis Metrology Index (p = 0.011), mSASSS (p = 0.035), and Bath Ankylosing Spondylitis patient global score-2 (BASG-2) (p = 0.032) and were more often smokers (p = 0.032). All women with a VF were postmenopausal. BMD was significantly lower at all measuring sites in the patients with VF. In logistic regression, high BASG-2, low BMD in femoral neck, and low lumbar vBMD were independently associated with presence of VF.
VF in AS are common but are often not diagnosed. VF are associated with advanced age, longstanding disease, impaired back mobility, syndesmophyte formation, and lower BMD in both the central and peripheral skeleton. BMD in the femoral neck, total hip, and estimated vBMD showed the strongest association with VF.
研究强直性脊柱炎（AS）患者的椎体骨折（VF）患病率和危险因素，以及不同测量部位的 VF 与疾病活动度指标和骨密度（BMD）之间的关系。
采用改良纽约标准诊断为 AS 的患者接受检查、问卷调查和血样采集。侧位脊柱 X 线片根据 Genant 评分评估 VF，并采用改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）评估脊柱融合情况。采用双能 X 线吸收法测量髋部、桡骨和腰椎前后位和侧位的 BMD，并估计体积 BMD（vBMD）。
共纳入 204 例（57%为男性）患者，平均年龄为 50±13 岁，病程为 15±11 年。24 例（12%）患者诊断为 VF，但仅 3 例患者此前临床上已注意到 VF。VF 患者明显更年长（p=0.004），病程更长（p=0.011），Bath 强直性脊柱炎测量指标（BASMI）更高（p=0.011），mSASSS 更高（p=0.035），Bath 强直性脊柱炎患者总体评分-2（BASG-2）更高（p=0.032），且更多为吸烟者（p=0.032）。所有患有 VF 的女性均绝经。VF 患者所有测量部位的 BMD 均显著降低。在 logistic 回归中，BASG-2 较高、股骨颈 BMD 较低和腰椎 vBMD 较低与 VF 的存在独立相关。
AS 患者的 VF 很常见，但常常未被诊断。VF 与高龄、长期疾病、脊柱活动受限、脊柱融合和中央及外周骨骼的 BMD 降低有关。股骨颈、全髋关节和估计 vBMD 的 BMD 与 VF 具有最强的相关性。
