Department of Orthopaedic Surgery, Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Orthopedic Surgery, Experimental Orthopedics, Centre for Medical Biotechnology (ZMB), University of Regensburg, Regensburg, Germany.
Front Immunol. 2023 Jun 8;14:1163258. doi: 10.3389/fimmu.2023.1163258. eCollection 2023.
BACKGROUND: Ankylosing Spondylitis (AS) is an inflammatory condition affecting the spine, which may lead to complications such as osteoporosis (OP). Many observational studies have demonstrated a close relationship with strong evidence between OP and AS. The combination of AS and OP is already an indisputable fact, but the exact mechanism of AS complicated with OP is unclear. To better prevent and treat OP in patients with AS, it is necessary to understand the specific mechanism of OP in these patients. In addition, there is a study showing that OP is a risk factor for AS, but the causal relationship between them is not yet clear. Therefore, we conducted a bidirectional Mendelian randomization (MR) analysis to determine whether there is a direct causal effect between AS and OP and to investigate the co-inherited genetic information between the two. METHODS: Bone mineral density (BMD) was used as a phenotype for OP. The AS dataset was taken from the IGAS consortium and included people of European ancestry (9,069 cases and 13,578 controls). BMD datasets were obtained from the GEFOS consortium, a large GWAS meta-analysis study, and the UK Biobank and were categorized based on site (total body (TB): 56,284 cases; lumbar spine (LS): 28,498 cases; femoral neck (FN): 32,735 cases; forearm (FA): 8,143 cases; and heel: 265,627 cases) and age (0-15: 11,807 cases; 15-30: 4,180 cases; 30-45: 10,062 cases; 45-60: 18,062 cases; and over 60: 22,504 cases).To obtain the casual estimates, the inverse variant weighted (IVW) method was mainly used due to its good statistical power and robustness. The presence of heterogeneity was evaluated using Cochran's Q test. Pleiotropy was assessed utilizing MR-Egger regression and MR-pleiotropy residual sum and outlier (MR-PRESSO). RESULTS: Generally, there were no significant causal associations between genetically predicted AS and decreased BMD levels. The results of MR-Egger regression, Weighted Median, and Weighted Mode methods were consistent with those of the IVW method. However, there was a sign of a connection between genetically elevated BMD levels and a decreased risk of AS (Heel-BMD: OR = 0.879, 95% CI: 0.795-0.971, = 0.012; Total-BMD: OR = 0.948, 95% CI: 0.907-0.990, = 0.017; LS-BMD: OR = 0.919, 95% CI: 0.861-0.980, = 0.010). The results were confirmed to be reliable by sensitivity analysis. CONCLUSION: This MR study found that the causal association between genetic liability to AS and the risk of OP or lower BMD in the European population was not evident, which highlights the second effect (e.g., mechanical reasons such as limited movement) of AS on OP. However, genetically predicted decreased BMD/OP is a risk factor for AS with a causal relationship, implying that patients with OP should be aware of the potential risk of developing AS. Moreover, OP and AS share similar pathogenesis and pathways.
背景:强直性脊柱炎(AS)是一种影响脊柱的炎症性疾病,可能导致骨质疏松症(OP)等并发症。许多观察性研究已经证明了 OP 和 AS 之间存在密切的关系,并提供了强有力的证据支持这一关联。AS 和 OP 的结合已经是一个不争的事实,但 AS 合并 OP 的具体机制尚不清楚。为了更好地预防和治疗 AS 患者的 OP,有必要了解这些患者中 OP 的具体机制。此外,有研究表明 OP 是 AS 的一个风险因素,但它们之间的因果关系尚不清楚。因此,我们进行了双向孟德尔随机化(MR)分析,以确定 AS 和 OP 之间是否存在直接的因果关系,并探讨两者之间共同遗传的信息。
方法:骨密度(BMD)被用作 OP 的表型。AS 数据集取自 IGAS 联合会,包括欧洲血统的人群(9069 例病例和 13578 例对照)。BMD 数据集来自 GEFOS 联合会,这是一项大型全基因组关联研究荟萃分析,以及英国生物银行,并根据部位(全身(TB):56284 例;腰椎(LS):28498 例;股骨颈(FN):32735 例;前臂(FA):8143 例;跟骨:265627 例)和年龄(0-15 岁:11807 例;15-30 岁:4180 例;30-45 岁:10062 例;45-60 岁:18062 例;60 岁以上:22504 例)进行分类。为了获得因果估计,主要使用逆方差加权(IVW)方法,因为它具有良好的统计功效和稳健性。使用 Cochran's Q 检验评估异质性的存在。使用 MR-Egger 回归和 MR-偏倚残差和异常值(MR-PRESSO)评估偏倚。
结果:一般来说,遗传预测的 AS 与降低的 BMD 水平之间没有显著的因果关系。MR-Egger 回归、加权中位数和加权模式方法的结果与 IVW 方法一致。然而,遗传上升高的 BMD 水平与 AS 风险降低之间存在关联的迹象(跟骨-BMD:OR = 0.879,95%CI:0.795-0.971, = 0.012;全身-BMD:OR = 0.948,95%CI:0.907-0.990, = 0.017;腰椎-BMD:OR = 0.919,95%CI:0.861-0.980, = 0.010)。敏感性分析结果证实了这一结果的可靠性。
结论:这项 MR 研究发现,欧洲人群中遗传易感性与 OP 或较低 BMD 风险之间的 AS 因果关系不明显,这突出了 AS 对 OP 的第二种效应(例如,活动受限等机械原因)。然而,遗传预测的降低的 BMD/OP 是 AS 的一个风险因素,具有因果关系,这意味着患有 OP 的患者应该意识到潜在的 AS 发病风险。此外,OP 和 AS 具有相似的发病机制和途径。
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