Kalman Laki Doctoral School of the University of Debrecen, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Blvd. 98, Debrecen, H-4032, Hungary.
BMC Musculoskelet Disord. 2021 Jan 12;22(1):70. doi: 10.1186/s12891-021-03952-z.
Skeletal manifestations are predominant in psoriatic arthritis (PsA). The aim of this cross-sectional, case-control study is the complex assessment of areal and volumetric bone mineral density (BMD), fracture risk, vitamin D status and bone turnover markers, and its association with disease-related variables.
Lumbar spine (L1-L4) and femoral neck (FN) areal, and distal radius (DR) volumetric BMD, 10-year probability of major and hip osteoporotic fracture as assessed by the fracture risk assessment (FRAX) tool, markers of bone metabolism and disease activity were assessed.
Upon comparison of the disease and age- and sex-matched control groups, there was a statistically significant difference in FN areal (0.952 (0.607-1.292) g/cm vs. 1.016 (0.760-1.550) g/cm; p = 0.001) and DR total volumetric (284.3 (138.9-470.3) mg/cm vs. 367.0 (287.0-412.0) mg/cm; p < 0.001) BMD, 10 year probability for major osteoporotic (3.7% (0.7-32%) vs. 2.6% (0-17.5%); p = 0.003) and hip (0.4% (0-16%) vs. 0.05% (0-6.1%); p = 0.002) fracture and 25-hydroxyvitamin D status (47.5 (10-120) nmol/L vs. 64 (10-137; p < 0.001) nmol/L). As compared to areal assessment, volumetric BMD measurements identified a significantly higher number of patients with low bone mineral density (T-Score ≤ - 1.00) (34% vs. 88%, p < 0.001). Upon multiple linear regression analysis, disease activity score, as determined by DAS28 assessment, was an independent predictor of 10-year probability for major osteoporotic fracture (B (95%CI) = 1.351 (0.379-2.323); p = 0.007).
In the studied PsA cohort, disease activity was an independent predictor of 10-year probability for a major osteoporotic fracture, and complemented assessment of volumetric and areal BMD assured better efficacy at identifying those with low bone mineral density.
骨表现是银屑病关节炎（PsA）的主要表现。本横断面病例对照研究的目的是对面积和体积骨矿物质密度（BMD）、骨折风险、维生素 D 状况和骨转换标志物进行复杂评估，并探讨其与疾病相关变量的关系。
评估腰椎（L1-L4）、股骨颈（FN）的面积和桡骨远端（DR）的体积 BMD、10 年主要和髋部骨质疏松性骨折的概率（使用骨折风险评估（FRAX）工具）、骨代谢和疾病活动的标志物。
与疾病组和年龄、性别匹配的对照组相比，FN 面积（0.952（0.607-1.292）g/cm 与 1.016（0.760-1.550）g/cm；p=0.001）和 DR 总容积（284.3（138.9-470.3）mg/cm 与 367.0（287.0-412.0）mg/cm；p<0.001）、10 年主要骨质疏松性骨折的概率（3.7%（0.7-32%）与 2.6%（0-17.5%）；p=0.003）和髋部骨折的概率（0.4%（0-16%）与 0.05%（0-6.1%）；p=0.002）和 25-羟维生素 D 状况（47.5（10-120）nmol/L 与 64（10-137；p<0.001）nmol/L）存在统计学差异。与面积评估相比，容积 BMD 测量方法可识别出更多低骨密度（T 评分≤-1.00）的患者（34%比 88%，p<0.001）。多元线性回归分析显示，DAS28 评估的疾病活动评分是 10 年主要骨质疏松性骨折概率的独立预测因子（B（95%CI）=1.351（0.379-2.323）；p=0.007）。
在本研究的 PsA 队列中，疾病活动是 10 年主要骨质疏松性骨折概率的独立预测因子，补充容积和面积 BMD 的评估可更好地识别低骨密度者。
