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Authors
Advisor(s)
Abstract(s)
Introdução: A osteoporose (OP) é comum na espondilite anquilosante, relacionada
tanto à inflamação sistémica quanto à diminuição da mobilidade. O risco de fratura
vertebral está aumentado. A maioria dos estudos mostra que pacientes com
espondilartrite axial (axSpA) têm prevalência de OP maior do que a esperada na
população geral.
Objetivos: Realizou-se um estudo transversal, descritivo e observacional sobre a
prevalência de OP, em adultos, com axSpA.
Métodos: Realizou-se um estudo observacional monocêntrico, transversal, envolvendo
doentes com critérios de classificação ASAS para espondilartrite seguidos numa Unidade
de Reumatologia, em Portugal, entre Março.2011 e Dezembro.2022. Recorreu-se,
retrospetivamente, a base de dados, recolhendo variáveis relacionadas com axSpA
(variáveis sociodemográficas e clínicas), incluindo parâmetros biológicos. Parâmetros de
saúde óssea foram adicionados, incluindo densitometria óssea, presença de
sindesmófitos, histórico de fraturas de fragilidade e tratamento anti-osteoporótico. A OP
foi definida por um T-score femoral ou lombar abaixo de -2,5 e/ou história de fratura
osteoporótica e/ou prescrição de fármacos antiosteoporóticos.
Resultados: Foram avaliados no estudo 43 pacientes (22 mulheres (51,2%); 21 homens
(48,8%)), com idade média de 52,19±10,9 anos e tempo de duração de doença de 6,69±
8,9 anos. A média do IMC foi de 26,84Kg/m2. Em relação aos medicamentos
antirreumáticos modificadores da doença, apenas um paciente (2,33%) utilizava
metotrexato. 21 pacientes (48,84%) utilizavam biológicos. Cinco pacientes (11,63%)
eram fumadores. As duas comorbilidades mais prevalentes foram hipertensão arterial e
obesidade (cada uma com 11 e 9 pacientes, respetivamente). Os níveis de vitamina D (T0)
foram menores (19,54ng/ml) do que o normal (>30ng/ml). A densidade mineral óssea
foi avaliada por densitometria na coluna lombar e colo do fémur em 10 pacientes
(23,26%). Segundo os critérios da Organização Mundial da Saúde (OMS), três pacientes
(30%) apresentaram OP e cinco (50%) osteopenia. Apenas um realizava tratamento antiosteoporótico. 15 pacientes (34,88%) efetuavam suplementação com vitamina D e 1
(2,33%) simultaneamente com cálcio e vitamina D. Dois pacientes apresentaram fraturas
prévias de baixo impacto. A presença de sindesmófitos foi encontrada em três pacientes
(6,98%). Conclusão: O rastreio de OP foi possível em 10 pacientes acompanhados por axSpA.
Devido a recursos limitados, o acesso a densitometria foi reduzido, contribuindo para
um possível atraso no diagnóstico de baixa densidade mineral óssea. Nestes 10
pacientes, este trabalho mostrou que 30% apresentava OP e 50% osteopenia de acordo
com os critérios da OMS. A prevalência de fraturas vertebrais no nosso estudo foi
4,65%, inferior às usualmente relatadas na literatura. A relação entre OP e fraturas
vertebrais na axSpA precisa ser estabelecida, mas o tamanho da amostra não foi grande
o suficiente para permitir tirar conclusões definitivas.
Background: Osteoporosis (OP) is common in ankylosing spondylitis, related to both systemic inflammation and decreased mobility. Vertebral fracture risk is increased. Most of the studies show that patients with axial spondyloarthritis (axSpA) have a higher prevalence of OP than that expected in the general population. Objectives: We performed a transversal, descriptive, observational study on osteoporosis (OP) in adults with axSpA. Methods: We performed a monocentric observational, transversal study involving patients fulfilling ASAS spondyloarthritis classification criteria followed in a Rheumatology Unit, in Portugal, between March.2011 and December.2022. We used the database retrospectively collecting axSpA related variables (sociodemographic and clinical variables) including biological parameters. Bone health parameters were added including bone densitometry, presence for syndesmophytes, history of fragility fractures and anti-osteoporotic treatment. OP was defined by a femoral or lumbar spine T-score below -2.5 and/or history of main osteoporotic fracture and/or prescription of antiosteoporotic drugs. Results: A total of 43 patients (22 female (51.2%); 21 male (48.8%)) took part in the study with a mean age of 52.19±10.9 years and disease duration 6.69± 8.9years. Average BMI was 26.84Kg/m2. Regarding disease-modifying antirheumatic drugs, only one patient (2.33%) was under methotrexate. 21 patients (48.84%) were on biologics. Five patients (11.63%) were smokers. The two most prevalent comorbid conditions were arterial hypertension and obesity (each with 11 and 9 patients, respectively). Vitamin D levels (T0) were lower (19.54ng/ml) than the normal range (>30ng/ml). Bone density was assessed by densitometry at the lumbar spine and femoral neck in 10 patients (23.26%). According to World Health Organization criteria (WHO), three (30%) of patients displayed OP and five (50%) osteopenia. Just one was on anti-osteoporosis treatment. 15 patients (34.88%) were on supplementation with vitamin D, and 1 (2.33%) simultaneously with calcium plus vitamin D. Two patients had previous low impact fractures. The presence of syndesmophytes was found in three patients (6.98%). Conclusion: Screening for OP was possible in 10 patients being followed for axSpA. Due to limited resources, access to bone densitometry was reduced, contributing for a potential delay in diagnosing low BMD. In this 10 patients this study showed that 30% displayed OP and 50% osteopenia, according to WHO criteria. The prevalence of vertebral fractures in our study was 4.65%, lower than those usually reported in the literature. The relationship between OP and vertebral fractures in axSpA needs to be established but the sample size was not large enough to enable us to draw definite conclusions.
Background: Osteoporosis (OP) is common in ankylosing spondylitis, related to both systemic inflammation and decreased mobility. Vertebral fracture risk is increased. Most of the studies show that patients with axial spondyloarthritis (axSpA) have a higher prevalence of OP than that expected in the general population. Objectives: We performed a transversal, descriptive, observational study on osteoporosis (OP) in adults with axSpA. Methods: We performed a monocentric observational, transversal study involving patients fulfilling ASAS spondyloarthritis classification criteria followed in a Rheumatology Unit, in Portugal, between March.2011 and December.2022. We used the database retrospectively collecting axSpA related variables (sociodemographic and clinical variables) including biological parameters. Bone health parameters were added including bone densitometry, presence for syndesmophytes, history of fragility fractures and anti-osteoporotic treatment. OP was defined by a femoral or lumbar spine T-score below -2.5 and/or history of main osteoporotic fracture and/or prescription of antiosteoporotic drugs. Results: A total of 43 patients (22 female (51.2%); 21 male (48.8%)) took part in the study with a mean age of 52.19±10.9 years and disease duration 6.69± 8.9years. Average BMI was 26.84Kg/m2. Regarding disease-modifying antirheumatic drugs, only one patient (2.33%) was under methotrexate. 21 patients (48.84%) were on biologics. Five patients (11.63%) were smokers. The two most prevalent comorbid conditions were arterial hypertension and obesity (each with 11 and 9 patients, respectively). Vitamin D levels (T0) were lower (19.54ng/ml) than the normal range (>30ng/ml). Bone density was assessed by densitometry at the lumbar spine and femoral neck in 10 patients (23.26%). According to World Health Organization criteria (WHO), three (30%) of patients displayed OP and five (50%) osteopenia. Just one was on anti-osteoporosis treatment. 15 patients (34.88%) were on supplementation with vitamin D, and 1 (2.33%) simultaneously with calcium plus vitamin D. Two patients had previous low impact fractures. The presence of syndesmophytes was found in three patients (6.98%). Conclusion: Screening for OP was possible in 10 patients being followed for axSpA. Due to limited resources, access to bone densitometry was reduced, contributing for a potential delay in diagnosing low BMD. In this 10 patients this study showed that 30% displayed OP and 50% osteopenia, according to WHO criteria. The prevalence of vertebral fractures in our study was 4.65%, lower than those usually reported in the literature. The relationship between OP and vertebral fractures in axSpA needs to be established but the sample size was not large enough to enable us to draw definite conclusions.
Description
Keywords
Densidade Mineral Óssea Espondilartrite Axial Espondilite Anquilosante Osteoporose Vitamina D