The risk of osteoporosis in patients with ankylosing spondylitis-A large retrospective matched cohort study
Med Clin (Barc). 2023 May 12;160(9):373-378.
doi: 10.1016/j.medcli.2022.10.013.
Epub 2023 Jan 23.
[Article in
English,
Spanish]
Affiliations
- 1 Department of Gastroenterology, Sheba Medical Centre, Tel-Hashomer, Israel; Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- 2 Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel.
- 3 Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- 4 Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
- 5 Chief Physicians Office, Clalit Health Services, Tel Aviv, Israel; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
- 6 Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: howard.amital@sheba.health.gov.il.
Abstract
Background:
Ankylosing spondylitis (AS) is associated with increased bone turnover and systemic inflammation. Osteoporosis is common but frequently underappreciated in AS, studies regarding the incidence of osteoporosis in AS are limited and based on small cohorts. The aim of this study is to assess the risk of osteoporosis in patients with AS compared to matched controls.
Methods:
A population based retrospective cohort study using data retrieved from a large electronic medical record in Israel, the Clalit health services. Included patients that were diagnosed with AS from January 2002 to December 2018 were followed for development of osteoporosis. The incidence of osteoporosis was compared between AS and controls and a logistic regression model was used to assess the interaction between AS and osteoporosis.
Results:
The study included 5476 AS patients, and 27,657 age- and sex-frequency matched controls. The incidence of osteoporosis in AS patients was significantly higher than controls (4.7% vs 2.8%, p<0.001) in the whole cohort as well as when stratified by sex. Osteoporosis developed earlier in patients with AS versus controls (4.1 vs 5.2 years, p<0.001). In multivariate analysis and after adjustment to several potential confounders, AS was found to independently associated with osteoporosis (HR 1.83, 95%CI 1.58-2.11, p<0.0001).
Conclusions:
Our study confirms the higher incidence and earlier development of osteoporosis in patients with AS. Such finding highlights the increased need of awareness and earlier detection of such comorbidity allowing prompt treatment to prevent undesired sequalae including increased risk of fractures.
Keywords:
Ankylosing spondylitis; Atención primaria; Epidemiology; Epidemiología; Espondilitis anquilosante; Osteoporosis; Primary care.
Copyright © 2022. Published by Elsevier España, S.L.U.
MeSH terms
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Cohort Studies
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Fractures, Bone*
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Humans
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Osteoporosis* / diagnosis
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Osteoporosis* / epidemiology
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Osteoporosis* / etiology
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Retrospective Studies
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Risk Factors
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Spondylitis, Ankylosing* / complications
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Spondylitis, Ankylosing* / diagnosis
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Spondylitis, Ankylosing* / epidemiology