BONE-MINERAL DENSITY AND VERTEBRAL COMPRESSION FRACTURE RATES IN ANKYLOSING-SPONDYLITIS

Objective-To examine the relationship between disease severity and bon e density as well as vertebral fracture risk in patients with ankylosi ng 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) a nd for the whole body using a hologic-QDR-1000/W absorptiometer. An al gorithm based on normal female ranges of vertebral heights was used to define a fracture as occurring when two vertebral ratios were each th ree standard deviations below the calculated mean of the controls. Res ults-Patients with AS had significantly lower FN-BMD in proportion to disease severity (based on a Schober index) and disease duration. LS-B MD 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 w ith a fracture of 1.9% in a control population of 1035 females of a si milar age range. Patients with AS with fractures were significantly ol der, more likely to be male, had longer disease duration and more adva nced spinal Limitation with less mobility. There was no significant re duction in lumbar spine or femoral neck bone density in the fracture g roup. Conclusions-Vertebral fractures that result from osteoporosis ar e 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 synd esmophyte formation and does not predict the risk of vertebral fractur e. Alternative sites such as the neck of the femur should be used for sequential assessment of BMD in AS.