Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Center of Bone diseases - Rheumatology Division, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland.
Bone. 2019 May;122:8-13. doi: 10.1016/j.bone.2019.01.024. Epub 2019 Jan 29.
To compare bone quality using the trabecular bone score (TBS) and bone microarchitecture in the distal tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) in ankylosing spondylitis (AS) patients and healthy controls (HC).
Areal bone mineral density (aBMD) and TBS (TBS iNsight software) were evaluated using DXA (Hologic, QDR 4500); while volumetric bone mineral density (vBMD) and bone microarchitecture were analyzed in the distal tibia using HR-pQCT (Scanco) in 73 male patients with AS and 52 age-matched HC.
AS patients were a mean 41.6 ± 7.9 years old and had a mean disease duration of 16.4 ± 8.6 y, with a mean mSASSS 25.6 ± 16.4. No difference was observed in lumbar spine aBMD in AS patients and HC (p = 0.112), but total hip BMD (p = 0.011) and TBS (p < 0.001) were lower in AS patients. In the distal tibia, reduced trabecular volumetric density [Tb.vBMD (p < 0.006)] and structural alterations - trabecular thickness (Tb.Th), p = 0.044 and trabecular separation (Tb.Sp), p = 0.039 - were observed in AS patients relative to controls. Further analysis comparing TBS < 1.310 and TBS ≥ 1.310 in AS patients revealed a higher mean body mass index [BMI] (p = 0.010), lower tibia cortical vBMD [Ct.vBMD] (p = 0.007), lower tibia cortical thickness [Ct.Th]: (p = 0.048) in the former group. On logistic regression analysis, BMI (OR = 1.27; 95%IC = 1.08-1.50, p = 0.005), (VF 4.65; 1.13-19.1, p = 0.033) and tibial Ct.vBMD (0.98; 0.97-1.00, p = 0.007) were associated with a lower TBS (<1.310).
The present study demonstrates that TBS and HR-pQCT imaging are important technologies evaluating bone impairment in AS patients. Moreover, in these patients vertebral fractures were associated with lower TBS.
比较强直性脊柱炎（AS）患者和健康对照（HC）者胫骨远端使用高分辨率外周定量 CT（HR-pQCT）评估的骨小梁骨评分（TBS）和骨微结构的骨质量。
使用 DXA（Hologic，QDR 4500）评估面积骨密度（aBMD）和 TBS（TBS iNsight 软件）；同时使用 HR-pQCT（Scanco）分析 73 名男性 AS 患者和 52 名年龄匹配的 HC 者胫骨远端的容积骨密度（vBMD）和骨微结构。
AS 患者平均年龄为 41.6±7.9 岁，平均病程为 16.4±8.6 年，平均 mSASSS 为 25.6±16.4。AS 患者和 HC 者的腰椎 aBMD 无差异（p=0.112），但全髋关节 BMD（p=0.011）和 TBS（p<0.001）较低。在胫骨远端，AS 患者的骨小梁体积密度降低[Tb.vBMD（p<0.006）]和结构改变-骨小梁厚度（Tb.Th），p=0.044 和骨小梁间隔（Tb.Sp），p=0.039-与对照组相比。对 AS 患者中 TBS<1.310 和 TBS≥1.310 进行进一步分析显示，前者组的平均体重指数（BMI）较高（p=0.010），胫骨皮质 vBMD 较低[Ct.vBMD]（p=0.007），胫骨皮质厚度[Ct.Th]较低（p=0.048）。在逻辑回归分析中，BMI（OR=1.27；95%CI=1.08-1.50，p=0.005）、VF（4.65；1.13-19.1，p=0.033）和胫骨皮质 Ct.vBMD（0.98；0.97-1.00，p=0.007）与较低的 TBS（<1.310）相关。
本研究表明 TBS 和 HR-pQCT 成像技术是评估 AS 患者骨损伤的重要技术。此外，在这些患者中，椎体骨折与较低的 TBS 相关。
