Bone Density, Bone Turnover and Fracture Risk in Ankylosing Spondylitis: A Randomized Placebo-Controlled Trial of Oral Alendronate
Abstract
Bone Mineral Density (BMD) is reduced in Ankylosing Spondylitis (AS) even in the early phase of the disease [1,2]. The degree of reported bone loss is variable, reflecting different study populations and disease durations, and the different techniques used to measure BMD. The reasons for this low BMD are multifactorial and may include inflammation associated with disease activity, immobility, vitamin D status, medication and altered sex hormone levels [3-6]. Reduced BMD is associated with an increased vertebral fracture rate in patients with AS compared to age and sex matched populations; these fractures may cause significant morbidity [4,7,8]. Vertebral fractures in AS may exacerbate spinal deformity, may present with acute pain, and in some cases neurological deficit [4,7-10]. It has also been suggested that microfractures occurring as a result of reduced bone mass may exacerbate pain and worsen deformity [1]. Bisphosphonates are potent inhibitors of bone resorption, acting by inhibiting osteoclast activity via inhibition of the enzyme farnesyl diphosphate synthase in the mevalonate pathway. In women and older men they improve BMD and in women have been proven to reduce vertebral, hip and other fractures. Preserving BMD in patients with AS may lead to a reduction in fractures, vertebral deformity and pain. A rise in BMD with an intravenous bisphosphonate (neridronate) was reported in a small (n= 30) open label study [11] but there is currently no consensus regarding…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 30 participants or records.
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