Toussirot E, Wendling D
Service de Rhumatologie (Pr Wendling), Hôpital Jean Minjoz, CHU, Besançon.
Presse Med. 1996 Apr 27;25(15):720-4.
Bone formation is classically observed in ankylosing spondylitis, but osteoporosis can also occur. This condition has been recognized for years on radiographs. Compared with controls, osteoporosis in ankylosing spondylitis is responsible for increasing the incidence of vertebral compression fractures and also explains spinal fractures after trauma, mainly observed at the cervical level. Measurement of bone mass is useful in diagnosing osteoporosis commonly observed in the lumbar spine and the femoral neck but not in the appendicular skeleton. Osteoporosis is seen early in the disease whereas increased bone mass is observed later or due to syndesmophyte formation. Osteoporosis in ankylosing spondylitis is probably a multi-factorial condition. Contributing factors are spine immobility secondary to ankylosis, inflammatory cytokines which enhance bone resorption, prolonged use of nonsteroidal antiinflammatory drugs and a deficit in sex hormone secretion. Furthermore, there is no alteration in calcium or phosphorus metabolism in ankylosing spondylitis. Finally, a study of bone morphometrics in the iliac crest region is required to better explain osteoporosis in ankylosing spondylitis.
在强直性脊柱炎中经典地观察到骨形成，但也可能发生骨质疏松。多年来，这种情况在X线片上已得到认可。与对照组相比，强直性脊柱炎中的骨质疏松会增加椎体压缩骨折的发生率，并且也解释了创伤后脊柱骨折的原因，主要发生在颈椎水平。骨量测量对于诊断腰椎和股骨颈常见的骨质疏松有用，但对四肢骨骼无用。骨质疏松在疾病早期出现，而骨量增加则在后期出现或由于韧带骨赘形成。强直性脊柱炎中的骨质疏松可能是一种多因素疾病。促成因素包括强直继发的脊柱活动受限、增强骨吸收的炎性细胞因子、长期使用非甾体抗炎药以及性激素分泌不足。此外，强直性脊柱炎患者的钙或磷代谢没有改变。最后，需要对髂嵴区域进行骨形态计量学研究，以更好地解释强直性脊柱炎中的骨质疏松。
