Department of Acupuncture and Moxibustion, Jiangbei District Hospital of Traditional Chinese Medicine, No.35, No.1 Village, Jianxin East Road, Jiangbei District, Chongqing, 400021, China.
Osteoporos Int. 2024 Jan;35(1):25-40. doi: 10.1007/s00198-023-06925-1. Epub 2023 Oct 9.
We included 39 studies in our meta-analysis, finding that patients with ankylosing spondylitis (AS) exhibit decreased bone mineral density (BMD) and an elevated risk of fractures. Additionally, we analyzed the risk factors associated with fractures in these patients.
AS is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, with reduced BMD, osteoporosis, and fractures being common complications. This study aims to systematically consolidate and conduct a meta-analysis of existing research to comprehensively understand decreased bone mineral density, osteoporosis, and fracture risks at various anatomical sites in AS patients. The objective is to provide reliable information for the management of AS patients and to inform clinical decision making.
We conducted a thorough search in various databases including Embase, PubMed, Cochrane Library, and Web of Science. These studies focused on the risk of and risk factors for decreased BMD, osteopenia, osteoporosis, and fractures at different sites among AS patients such as the lumbar spine and femoral neck. The quality of eligible studies was evaluated. Sensitivity analysis was performed to assess the reliability of our analysis results and understand the effects of individual studies on the heterogeneity across studies.
A total of 39 studies were included. Our meta-analysis results revealed significant differences between AS patients and healthy controls. AS patients had significantly lower BMDs at the femoral neck, hip, lumbar vertebra 2 (L2), lumbar vertebra 3 (L3), and lumbar vertebra 4 (L4), but higher BMDs at 1/3 distal radius and ultra distal radius. Risk factors for fractures among AS patients included old age, long course of disease, and low BMD at the lumbar spine. In contrast, factors such as erythrocyte sedimentation rate (ESR), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, gender, and body mass index (BMI) were not risk factors for fractures in AS patients.
Our study highlights that BMD at the femoral neck is more effective for evaluating AS patients compared with the BMD at the lumbar spine. Additionally, the risk of osteoporosis and fractures in AS patients is higher in younger patients and those at the early stage of this disease.
我们的荟萃分析纳入了 39 项研究，结果表明强直性脊柱炎（AS）患者的骨密度（BMD）降低，骨折风险增加。此外，我们还分析了这些患者骨折的相关危险因素。
AS 是一种主要影响脊柱和骶髂关节的慢性炎症性疾病，常见的并发症包括 BMD 降低、骨质疏松症和骨折。本研究旨在系统地整合和分析现有研究，全面了解 AS 患者各解剖部位的骨密度降低、骨质疏松症和骨折风险。目的是为 AS 患者的管理提供可靠信息，并为临床决策提供依据。
我们在 Embase、PubMed、Cochrane 图书馆和 Web of Science 等多个数据库中进行了全面检索。这些研究集中于 AS 患者腰椎和股骨颈等不同部位的 BMD 降低、骨量减少、骨质疏松症和骨折风险，以及风险因素。评估了合格研究的质量。进行敏感性分析以评估我们分析结果的可靠性，并了解个别研究对研究间异质性的影响。
共纳入 39 项研究。我们的荟萃分析结果显示，AS 患者与健康对照组之间存在显著差异。AS 患者的股骨颈、髋部、腰椎 2（L2）、腰椎 3（L3）和腰椎 4（L4）的 BMD 明显较低，但 1/3 远端桡骨和超远端桡骨的 BMD 较高。AS 患者骨折的危险因素包括年龄较大、病程较长以及腰椎 BMD 较低。相比之下，红细胞沉降率（ESR）、巴斯强直性脊柱炎疾病活动指数（BASDAI）评分、性别和体重指数（BMI）等因素不是 AS 患者骨折的危险因素。
我们的研究表明，与腰椎 BMD 相比，股骨颈 BMD 更能有效地评估 AS 患者。此外，AS 患者骨质疏松症和骨折的风险在年轻患者和疾病早期患者中更高。
