Ankylosing spondylitis and bone mineral density-what is the ideal tool for measurement?
Ankylosing spondylitis and bone mineral density-what is the ideal tool for measurement?
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DOI：
10.1007/s00296-004-0515-4
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发表时间：
2005-12-01
影响因子：
4
通讯作者：
Bachmann, G
中科院分区：
文献类型：
--
作者：
Lange, U;Kluge, A;Bachmann, G
强直性脊柱炎（AS）的特点是慢性炎症和部分骨化，而骨质疏松症引起的椎骨骨折虽然常见，但常常未被识别。本研究的目的是 (1) 显示 AS 骨质减少/骨质疏松进展的变化频率，具体取决于疾病的持续时间和阶段，以及 (2) 评估该临床模式中两种不同骨密度测量方法的排名。我们使用双 X 射线吸收仪 (DXA) 和单能量定量计算机断层扫描 (SE-QCT) 测量了 84 名男性和女性患者的骨密度。在疾病的初期和晚期，可证实轴骨密度大幅下降（DXA：骨质减少5%，骨质疏松9.2%；SE-QCT：骨质减少11.8%，骨质疏松30.3%）。通过 DXA 测量可证明 17.6% 的周围骨密度降低为骨质减少。通过SE-QCT，在初始阶段就可以观察到椎骨小梁骨密度的下降，并在病程中持续稳定地下降；皮质骨在强直阶段也表现出相同的趋势。通过 DXA，在不太明显的强直性强直阶段更有可能得出有效的结论。在椎体区域的晚期强直（大量韧带骨赘）阶段，由于对小梁骨和皮质骨的选择性测量，应优先考虑 SE-QCT。 DXA 方法经常产生过高的值，并且脂肪骨髓替代椎骨小梁通常不被记录为标准。在 DXA 骨质减少以及 SE-QCT 已确定的骨质疏松症中，AS 骨折的风险可能已经增加。
Ankylosing spondylitis (AS) is characterised by chronic inflammation and partial ossification, yet vertebral fractures due to osteoporosis, although common, are frequently unrecognised. The aim of this study was to (1) show the frequency of changes in the progress of osteopenia/osteoporosis in AS depending on duration and stage of the disease and (2) assess the ranking of two different methods of bone density measurement in this clinical pattern. We measured bone density in 84 male and female patients with both dual X-ray absorptiometry (DXA) and single energy quantitative computed tomography (SE-QCT). In the initial and advanced stages of the disease, a high decrease in axial bone density could be verified (DXA: osteopenia in 5% and osteoporosis in 9.2%; SE-QCT: osteopenia in 11.8% and osteoporosis in 30.3%). Peripheral bone density decrease as in osteopenia could be proven in 17.6% by DXA measurement. With SE-QCT, a decrease in vertebral trabecular bone density could already be observed in the initial stage and continued steadily during the course of the disease; cortical bone displayed the same trend up to stages of ankylosis. With DXA, valid conclusions are more likely to be expected in less marked ankylosing stages of AS. In stages of advanced ankyloses in the vertebral region (substantial syndesmophytes), priority should be given to SE-QCT, due to the selective measurement of trabecular and cortical bone. The DXA method often yields values that are too high, and the replacement of vertebral trabecular bone by fatty bone marrow is not usually recorded as standard. There may already be an increased risk of bone fracture in AS in osteopenia on DXA along with an osteoporosis already established on SE-QCT.