脊柱关节炎与骨质疏松症关系的综述

W. Kwok, H. Chung
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引用次数: 1

摘要

引言:研究脊柱关节炎(SpA)与骨质疏松症之间的关系,包括任何关联或预测,从而提出SpA骨质疏松症的筛查和管理计划。方法:分别在Medline和PubMed上收集1990年至2021年间以“骨质疏松症”、“脊椎关节炎”或“强直性脊柱炎”为关键词的168篇和538篇研究文章。对34篇文章进行了重点审查。结果:不同国家的多项研究表明,骨质疏松症是强直性脊柱炎和脊椎关节病的常见合并症,骨密度(BMD)降低,椎骨和股骨近端皮质骨的骨微结构改变,导致椎骨骨折和少肌症的风险增加。相关因素包括男性、高龄、疾病持续时间长、血清血沉(ESR)高、股骨和腰椎侧骨密度降低以及高放射学指标。它可能与慢性全身炎症和不动有关。血清尿酸水平、某些基因和抗体也可能与病理有关。SpA中骨质疏松的可能性可以通过骨小梁评分来评估,骨小梁得分与血清ESR和C反应蛋白(CRP)水平呈负相关。阿仑膦酸盐与充足的钙和维生素D的饮食摄入是推荐的管理。结论:由于长期存在促炎细胞因子、功能损伤和类固醇治疗,SpA患者的骨质疏松症患病率较高。借助炎症标志物、影像学和放射学指标,可以预测骨质疏松症和脊椎骨折的风险。应修改管理计划,将骨质疏松症的预防和治疗纳入其中。
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Review Article on the Relationship between Spondyloarthritis and Osteoporosis
Introduction: To investigate the relationship between spondyloarthritis (SpA) and osteoporosis including any association or prediction, and hence suggesting a plan of screening and management for osteoporosis in SpA. Methods: 168 and 538 research articles with keywords “osteoporosis” and “spondyloarthritis” or “ankylosing spondylitis” conducted between 1990 and 2021 were collected in Medline and PubMed, respectively. Focused review was conducted in 34 articles. Results: Osteoporosis is a common comorbidity in both ankylosing spondylitis and spondyloarthropathy as suggested by multiple studies across different countries, with a reduction in bone mineral density (BMD) and altered bone microarchitecture in vertebrae and cortical bone of proximal femur, leading to an increased risk of vertebral fractures and sarcopenia. Associated factors include male sex, advanced age, long disease duration, high serum erythrocyte sedimentation rate (ESR), decreased femoral and lateral lumbar BMD, and high radiological indices. It is likely to be related to chronic systemic inflammation and immobility. Serum uric acid level, certain genes and antibodies may also contribute to the pathology. The likelihood of osteoporosis in SpA can be evaluated by trabecular bone score, which are negatively correlated with serum levels of ESR and C-reactive protein (CRP). Alendronate with adequate dietary intake of calcium and vitamin D is the recommended management. Conclusion: The prevalence of osteoporosis is higher in patients with SpA due to the chronic presence of pro-inflammatory cytokines, functional impairment, and steroid therapy. With the help of inflammatory markers, imaging and radiological indices, the risk of osteoporosis, and vertebral fractures can be predicted. The management plan should be modified to include prevention and treatment of osteoporosis.
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