BONE-MINERAL DENSITY AND VERTEBRAL COMPRESSION FRACTURE RATES IN ANKYLOSING-SPONDYLITIS
BONE-MINERAL DENSITY AND VERTEBRAL COMPRESSION FRACTURE RATES IN ANKYLOSING-SPONDYLITIS
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DOI：
10.1136/ard.53.2.117
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发表时间：
1994-02-01
影响因子：
27.4
通讯作者：
SPECTOR, TD
中科院分区：
文献类型：
--
作者：
DONNELLY, S;DOYLE, DV;SPECTOR, TD
目的：探讨强直性脊柱炎(AS)患者病情严重程度与骨密度及椎体骨折危险性的关系。方法：对87例强直性脊柱炎患者进行骨密度(BMD)和椎体骨折率测量。使用HOLOGIC-QDR-1000/W骨密度仪测量髋部(股骨颈-FN)、腰椎(L1-L4-LS)和全身的骨密度。一种基于正常女性椎体高度范围的算法被用来定义为当两个椎体比率分别比对照组计算的平均值低三个标准差时发生骨折。结果：AS患者的FN-BMD显著低于疾病严重程度(基于Schober指数)和病程。LS-BMD在早期疾病中也降低了，但在晚期患者中则显著增加。9个脊椎骨折(10.3%)被确认，这比预期的要高得多，而在1035名年龄范围相似的对照人群中，骨折的比例为1.9%。合并骨折的强直性脊柱炎患者年龄更大，更可能是男性，病程更长，脊柱受限程度更高，活动能力更差。骨折组腰椎或股骨颈骨密度无明显下降。结论--骨质疏松导致的椎体骨折是长期强直性脊柱炎的一个特征。在晚期强直性脊柱炎中，骨密度作为脊柱骨质疏松的指标是不可靠的，可能是由于椎间突起的形成，并且不能预测脊柱骨折的风险。对于强直性脊柱炎患者骨密度的序贯评估，应使用替代部位，如股骨颈。
Objective-To examine the relationship between disease severity and bone density as well as vertebral fracture risk in patients with ankylosing spondylitis (AS). Methods-Measurements were taken for bone mineral density (BMD) and vertebral fracture rates in 87 patients with AS. BMD was measured at the hip (femoral neck -FN), lumbar spine (L1-L4-LS) and for the whole body using a hologic-QDR-1000/W absorptiometer. An algorithm based on normal female ranges of vertebral heights was used to define a fracture as occurring when two vertebral ratios were each three standard deviations below the calculated mean of the controls. Results-Patients with AS had significantly lower FN-BMD in proportion to disease severity (based on a Schober index) and disease duration. LS-BMD was also reduced in early disease, but in patients with advanced AS it had increased considerably. Nine vertebral fractures (10.3%) were identified which was considerably higher than expected when compared with a fracture of 1.9% in a control population of 1035 females of a similar age range. Patients with AS with fractures were significantly older, more likely to be male, had longer disease duration and more advanced spinal Limitation with less mobility. There was no significant reduction in lumbar spine or femoral neck bone density in the fracture group. Conclusions-Vertebral fractures that result from osteoporosis are a feature of longstanding AS. BMD used as a measure of osteoporosis of the spine in advanced AS is unreliable probably as a result of syndesmophyte formation and does not predict the risk of vertebral fracture. Alternative sites such as the neck of the femur should be used for sequential assessment of BMD in AS.