Machado Natalia P, Pinheiro Marcelo M, Chula Domingos C, Ceron Rafaela, Pinheiro Francisco I, Serrato Varlei A, Azevedo Valderílio F, Moreira Carolina A
Rheumatology Division, Federal University of Parana (UFPR), Paulo Graeser Sobrinho Street 792, House 3, ZIP Code 80510372, Curitiba, PR, Brazil.
Rheumatology Division, Federal University of São Paulo (UNIFESP/ EPM), São Paulo, SP, Brazil.
Calcif Tissue Int. 2025 Jan 3;116(1):17. doi: 10.1007/s00223-024-01314-0.
Patients with radiographic axial spondyloarthritis (r-axSpA) experience a higher prevalence of fragility fractures, though the pathophysiology of osteoporosis associated with this disease remains poorly understood. The objective of this study was to evaluate the histomorphometric data in r-axSpA patients. Male r-axSpA patients up to 55 years old were enrolled in this cross-sectional study. Clinical, lab, and imaging data, including spine X-Ray to evaluate vertebral fractures and new bone formation, as well as dual-energy X-ray absorptiometry (DXA) at spine, hip, and forearm and trabecular bone score (TBS), were performed in all patients. Transiliac histomorphometry was also underwent in all patients, and data were compared with 21 male cadavers' material. A total of 21 patients were included, with a mean age of 45.8 years, long disease duration (median 17.5 years), mostly white (66.7%) and positive for HLA-B27 (90.5%). The prevalence of DXA abnormalities and low TBS (≤ 1.338) was 42.8% and 57.1%, respectively. There was higher osteoid trabecular thickness (p = 0.027) and cortical bone changes, including reduced thickness (p = 0.031) and increased porosity (p = 0.015) in r-axSpA patients. In addition, a pattern of cortical trabecularization was observed in 52.3%. Dynamic evaluation revealed a longer mineralization lag time (p = 0.0074) and lower mineralized surface (p = 0.0029) and bone formation rate (p = 0.0074) in patients compared to reference values. Our results showed a pattern of low trabecular remodeling, bone mineralization impairment, as well as cortical thickness and porosity abnormalities in men with r-axSpA. These findings may impact future treatment of bone fragility in this disease.
放射学轴性脊柱关节炎（r-axSpA）患者发生脆性骨折的患病率较高，尽管与该疾病相关的骨质疏松症的病理生理学仍知之甚少。本研究的目的是评估r-axSpA患者的组织形态计量学数据。本横断面研究纳入了年龄在55岁以下的男性r-axSpA患者。对所有患者进行了临床、实验室和影像学检查，包括用于评估椎体骨折和新骨形成的脊柱X线检查，以及脊柱、髋部和前臂的双能X线吸收法（DXA）和骨小梁评分（TBS）。所有患者还接受了髂骨组织形态计量学检查，并将数据与21具男性尸体的材料进行了比较。共纳入21例患者，平均年龄45.8岁，病程长（中位数17.5年），大多为白人（66.7%），HLA-B27阳性（90.5%）。DXA异常和低TBS（≤1.338）的患病率分别为42.8%和57.1%。r-axSpA患者的类骨质骨小梁厚度更高（p = 0.027），皮质骨有变化，包括厚度降低（p = 0.031）和孔隙率增加（p = 0.015）。此外，52.3%的患者观察到皮质骨小梁化模式。动态评估显示，与参考值相比，患者的矿化延迟时间更长（p = 0.0074）、矿化表面更低（p = 0.0029）和骨形成率更低（p = 0.0074）。我们的结果显示，r-axSpA男性患者存在骨小梁重塑低、骨矿化受损以及皮质厚度和孔隙率异常的模式。这些发现可能会影响该疾病未来的骨脆性治疗。
