Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes?

Abstract

Introduction and objectives: Syndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis.

Material and methods: From January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables.

Results: The study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7±10.27years and 44.36±11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345±0.14 and 1.41±0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score.

Conclusion: Trabecular bone scores do not appear to be masked by the presence of syndesmophytes.

Keywords: Espondiloartritis; Osteoporosis; Puntuación de hueso trabecular; Sindesmofito; Spondyloarthritis; Syndesmophyte; Trabecular bone score.