Online ISSN: 3007-0244,
Print ISSN:  2410-4280
Ankylosing spondylitis (AS), despite the development of modern science of rheumatic diseases, remains an insufficiently studied pathology. Paradoxical for AS is the simultaneous activation of two opposing processes: osteoneogenesis and osteoporosis (OP). We have described two clinical cases of patients with AS, diagnosed in the cardio-rheumatology department of the University Hospital of Semey Medical University, where the opposing processes of osteoneogenesis and OP coexist and predispose to pathological fracture of the spine. Risk factors for OP such as duration of the disease, persistent high activity, C-reactive protein, BASDAI and BASFI indices and reduced bone density values, along with a high process of osteogenesis - an immobilized spine due to ankylosis, prolonged use of non-steroidal anti-inflammatory drugs and the lack of effect of basic therapy led to a fracture spine in the clinical case of patient C. and suggests a high risk of fracture in the case of patient M. To address the problem of pathological fractures in AS patients, early monitoring of bone mineral density, further studies of the clinical use of DXA to assess the risk of fractures, and timely use of medications for the prevention and treatment of OP in AS are required.
Madina R. Madieva1*, Alida Sh. Kaskabaeva1, Tamara Kh. Rymbaeva1, Gulzhan B. Bersimbekova1, Gulnur B. Kanapiyanova1, Arai K. Mukanova1, 1 NCJSC “Semey Medical University”, Semey, Republic of Kazakhstan.
1. Adami G., Fassio A., Rossini M. et al. Osteoporosis in Rheumatic Diseases // Int J Mol Sci. 2019 Nov 22. 20(23):5867. doi: 10.3390/ijms20235867. PMID: 31766755, PMCID: PMC6928928. 2. Briot K., Durnez A., Paternotte S. et al. Bone Oedema on MRI is Highly Associated with Low Bone Mineral Density in Patients with Early Inflammatory Back Pain: Results from the DESIR Cohort // Ann. Rheum. Dis. 2013. 72:1914–1919. doi:10.1136/annrheumdis-2012-201845 3. Davey-Ranasinghe N., Deodhar A. Osteoporosis and vertebral fractures in ankylosing spondylitis // Current Opinion in Rheumatology, 2013. 25(4), 509–516. doi:10.1097/bor.0b013e3283620777 4. Dougados M., Baeten D. Spondyloarthritis // Lancet. 2011 Jun 18. 377(9783):2127-37. doi: 10.1016/S0140-6736(11)60071-8. PMID: 21684383. 5. Eugene V. McCloskey, Anders Odén, Nicholas C. Harvey et al. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. 6. Geusens P., de Winter L., Quaden D. et al. The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma // Arthritis Res Ther. 2015. 17. 294. 7. Ghozlani I., Ghazi M., Nouijai A. et al. Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. 8. Harry K. Genant, Jiao Li et al. Vertebral Fractures in Osteoporosis: A New Method for Clinical Assessment. Journal of Clinical Densitometry Volume 3, Issue 3, Autumn 2000, Pages 281-290, 9. Kang K.Y., Ju J.H., Park S.H. et al. Longitudinal association between trabecular bone loss and disease activity in axial spondyloarthritis: A 4-year prospective study. J. Rheumatol. 2020. 47(9):1330–1337. 10. Spoorenberg A., Van Der Slik B.P.G. et al. Clinical Risk Factors for the Presence and Development of Vertebral Fractures in Patients with Ankylosing Spondylitis // Arthritis Care Res. 2017. 69:694–702. doi: 10.1002/acr.22980 11. Malochet-Guinamand S., Pereira B., Tatar Z. et al. Prevalence and risk factors of low bone mineral density in spondyloarthritis and prevalence of vertebral fractures // BMC Musculoskelet Disord. 2017 Aug 22. 18(1):357. doi: 10.1186/s12891-017-1718-7. 12. Muñoz-Ortego J., Vestergaard P., Rubio J.B., et al. Ankylosing spondylitis is associated with an increased risk of vertebral and nonvertebral clinical fractures: a population-based cohort study // J Bone Miner Res. 2014. 29(8):1770–1776. doi: 10.1002/jbmr.2217 13. Pannarat S., Ajanee M., Chatlert P. et al. Prevalence of low trabecular bone score and its association with disease severity and activity in patients with axial spondyloarthritis // Sci Rep. 2023. 13: 16258. doi: 10.1038/s41598-023-43321-5 14. Piet G., De Winter L., Quaden D. et al. The prevalence of vertebral fractures in spondyloarthritis: relation to disease characteristics, bone mineral density, syndesmophytes and history of back pain and trauma // Arthritis Res Ther. 2015. 17: 294. doi:10.1186/s13075-015-0809-9 15. Pray C., Feroz N.I., Nigil H.N. Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis // Calcif Tissue Int. 2017. 101(2):182–192. doi:10.1007/s00223-017-0274-3. 16. Prieto-Alhambra D., Munoz-Ortego J., De Vries F. et al. Ankylosing spondylitis confers substantially increased risk of clinical spine fractures: A nationwide case–control study // Osteoporos. 2015. 26(1):85–91. 17. Ramírez J., Nieto-González J.C., Curbelo Rodríguez R. et al. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: a systematic review and meta-analysis // Semin Arthritis Rheum. 2018. 48(1):44–52. doi: 10.1016/j.semarthrit.2017.12.001 18. Ulu M.A., Batmaz I., Dilek B. et al. Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis // Chin Med J. (Engl). 2014. 127(15):2740–2747 19. Valls-Pascual E., Orenes-Vera A.V., Sendra-Garcia A., et al. Relationship between trabecular bone score, bone mineral density and vertebral fractures in patients with axial spondyloarthritis // BMC Musculoskelet Disord. 2023 Apr 22. 24(1):316. doi: 10.1186/s12891-023-06431-9.
Number of Views: 576

Category of articles: Clinical case

Bibliography link

Madieva M.R., Kaskabaeva A.Sh., Rymbaeva T.Kh., BersimbekovA G.B., Kanapiyanova G.B., Mukanova A.K. Activation of opposite processes – osteoporosis and osteogenesis in ankylosing spondylitis using the clinical cases // Nauka i Zdravookhranenie [Science & Healthcare]. 2024, (Vol.26) 1, pp. 253-258. doi 10.34689/SH.2024.26.1.030

Авторизируйтесь для отправки комментариев