Yaşlı ankilozan spondilitli hastalarda kırık riski ve ilişkili faktörler

Nuh Ataş; Burcu Candemir; Murat Torgutalp; Hakan Babaoğlu; Hasan Satış; Reyhan Bilici Salman; Hazan Karadeniz; Aslıhan Avanoğlu Güler; Gülşah Atbiner Eroğlu; Berna Göker; Mehmet Akif Öztürk; Abdurrahman Tufan; Şeminur Haznedaroğlu

doi:10.4274/raed.galenos.2021.29591

Yaşlı ankilozan spondilitli hastalarda kırık riski ve ilişkili faktörler

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Orijinal Araştırma

Yaşlı ankilozan spondilitli hastalarda kırık riski ve ilişkili faktörler

J Turk Soc Rheumatol 2021;13(2):59-65 DOI: 10.4274/raed.galenos.2021.29591

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İzin

Öz

Amaç:

Osteopeni/osteoporoz ve kırıklar ankilozan spondilitte (AS) görülebilen önemli problemlerdir. Genç AS hastalarında bu problemler yoğun olarak çalışılmışken, yaşlı AS hastalarında yeterli veri bulunmamaktadır. Bu çalışmada, yaşlı AS hastalarında kırık riski ve ilişkili faktörleri ve düşük kemik mineral yoğunluğu (KMY) sıklığını araştırdık.

Yöntem:

Bu çalışmaya 20 yaşlı (≥65 yaş) AS hastası ve 21 yaş/cinsiyet olarak eşleştirilmiş kontrol grubu dahil edildi. Bütün AS hastaları modifiye New York kriterlerini karşılamaktaydı. KMY ölçümü için çift X-ışınlı absorpsiyometri, kırık riski hesaplanması için ise Kırık Riski Değerlendirme Aracı kullanıldı. Hastaların demografik, klinik ve radyografik özellikleri değerlendirildi.

Bulgular:

Osteoporoz oranı yaşlı AS hastalarında %35, kontrol grubunda ise %4,8 idi (p=0,034). Düşük KMY (osteopeni ve/veya osteoporoz) oranı AS hastalarında (14/20, %70) femur boyun bölgesinde, kontrol grubuna (8/21, %38) göre daha yüksek iken (p=0,041), lomber vertebra ve total kalça ölçümlerinde anlamlı fark görülmedi. Majör osteoporotik ve kalça kırık riski her iki grupta da benzer idi. C-reaktif protein (CRP), yaşlı AS hastalarında hem majör osteoporotik [odds oranı (OR): 0,969; %95 güven aralığı (GA) 0,61-1,32; p=0,001] hem de kalça kırık riski (OR: 0,775; %95 GA 0,47-1,08; p<0,001) için bağımsız bir risk faktörüydü.

Sonuç:

Düşük KMY yaşlı AS hastalarında kontrollere göre daha sıktı. CRP, 10 yıllık kırık riskinin bağımsız bir risk faktörü olup, yüksek CRP’li yaşlı AS hastalarında kırıklar için etkin önleyici stratejilerin geliştirilmesi gereklidir.

Anahtar Kelimeler: Ankilozan spondilit, yaşlılık, kırık riski, CRP, kemik mineral dansitesi

Kaynakça

1

Sieper J, Appel H, Braun J, Rudwaleit M. Critical appraisal of assessment of structural damage in ankylosing spondylitis: implications for treatment outcomes. Arthritis Rheum 2008;58:649-56.

2

Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003;23:61-6.

3

Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998;41:58-67.

4

Stolwijk C, van Tubergen A, Castillo-Ortiz JD, Boonen A. Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis. Ann Rheum Dis 2015;74:65-73.

5

Davey-Ranasinghe N, Deodhar A. Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol 2013;25:509-16.

6

van der Weijden MA, Claushuis TA, Nazari T, et al. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: a systematic review. Clin Rheumatol 2012;31:1529-35.

7

Moltó A, Etcheto A, van der Heijde D, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis 2016;75:1016-23.

8

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001;285:785-95.

9

Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA 2002;288:1889-97.

10

van der Weijden MA, van der Horst-Bruinsma IE, van Denderen JC, et al. High frequency of vertebral fractures in early spondylarthropathies. Osteoporos Int 2012;23:1683-90.

11

Jun JB, Joo KB, Her MY, Kim TH, Bae SC, Yoo DH, Kim SK. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 2006;33:1637-41.

12

Vosse D, Landewé R, van der Heijde D, van der Linden S, van Staa TP, Geusens P. Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study. Ann Rheum Dis 2009;68:1839-42.

13

Harvey N, Dennison E, Cooper C. Osteoporosis: impact on health and economics. Nat Rev Rheumatol 2010;6:99-105.

14

Feldtkeller E, Vosse D, Geusens P, van der Linden S. Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int 2006;26:234-9.

15

Vosse D, van der Heijde D, Landewé R, et al. Determinants of hyperkyphosis in patients with ankylosing spondylitis. Ann Rheum Dis 2006;65:770-4.

16

Schiefer TK, Milligan BD, Bracken CD, et al. In-hospital neurologic deterioration following fractures of the ankylosed spine: a single-institution experience. World Neurosurg 2015;83:775-83.

17

Hallberg I, Bachrach-Lindström M, Hammerby S, Toss G, Ek AC. Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study. BMC Musculoskelet Disord 2009;10:135.

18

van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-8.

19

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137-1141.

20

No authors listed. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994;843:1-129.

21

Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 1998;8:468-89.

22

Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007;18:1033-46.

23

Sambrook PN, Geusens P. The epidemiology of osteoporosis and fractures in ankylosing spondylitis. Ther Adv Musculoskelet Dis 2012;4:287-92.

24

Fitzgerald G, Anachebe T, McCarroll K, O’Shea F. Measuring bone density in axial spondyloarthropathy: Time to turn things on their side? Int J Rheum Dis 2020;23:358-66.

25

Deminger A, Klingberg E, Lorentzon M, et al. Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study. Arthritis Res Ther 2017;19:273.

26

Sampaio-Barros PD, Bertolo MB, Kraemer MH, Neto JF, Samara AM. Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients. J Rheumatol 2001;28:560-5.

27

Ramírez J, Nieto-González JC, Curbelo Rodríguez R, Castañeda S, Carmona L. Prevalence and risk factors for osteoporosis and fractures in axial spondyloarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2018;48:44-52.

28

Nielson CM, Srikanth P, Orwoll ES. Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res 2012;27:1-10.

29

Johnell O, Gullberg B, Kanis JA, et al. Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 1995;10:1802-15.

30

Joakimsen RM, Fønnebø V, Magnus JH, Tollan A, Søgaard AJ. The Tromsø Study: body height, body mass index and fractures. Osteoporos Int 1998;8:436-42.

31

Kanis J, Johnell O, Gullberg B, et al. Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int 1999;9:45-54.

32

Compston JE, Watts NB, Chapurlat R, et al; Glow Investigators. Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 2011;124:1043-50.

33

Nielson CM, Marshall LM, Adams AL, et al; Osteoporotic Fractures in Men Study Research Group. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 2011;26:496-502.

34

Pirro M, Fabbriciani G, Leli C, et al. High weight or body mass index increase the risk of vertebral fractures in postmenopausal osteoporotic women. J Bone Miner Metab 2010;28:88-93.

35

Chan MY, Frost SA, Center JR, Eisman JA, Nguyen TV. Relationship between body mass index and fracture risk is mediated by bone mineral density. J Bone Miner Res 2014;29:2327-35.

36

Ghozlani I, Ghazi M, Nouijai A, et al. Prevalence and risk factors of osteoporosis and vertebral fractures in patients with ankylosing spondylitis. Bone 2009;44:772-6.

37

Klingberg E, Lorentzon M, Mellström D, et al. Osteoporosis in ankylosing spondylitis - prevalence, risk factors and methods of assessment. Arthritis Res Ther 2012;14:R108. doi: 10.1186/ar3833.

38

Redlich K, Smolen JS. Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 2012;11:234-50.

39

Kang KY, Kwok SK, Ju JH, Hong YS, Park SH. Assessment of fracture risk in patients with axial spondyloarthritis: a case-control study using the fifth Korean National Health and Nutrition Examination Survey (KNHANES V). Scand J Rheumatol 2016;45:23-31.

40

Kim HN, Jung JY, Hong YS, Park SH, Kang KY. Severe bone marrow edema on sacroiliac joint MRI increases the risk of low BMD in patients with axial spondyloarthritis. Sci Rep 2016;6:22158. doi: 10.1038/srep22158.

41

Park JS, Hong JY, Park YS, Han K, Suh SW. Trends in the prevalence and incidence of ankylosing spondylitis in South Korea, 2010-2015 and estimated differences according to income status. Sci Rep 2018;8:7694.