Meeting abstract

IMPORTANCE OF TRABECULAR BONE SCORE IN FRACTURE RISK PREDICTION IN RHEUMATOID ARTHRITIS AND ANKYLOSING SPONDYLITIS.

Zdenko Killinger ; Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava, Bratislava, Slovakia

Abstract

One of the most deleterious eff ectsinduced by the chronic inflammation is bone loss.Fracture is one of the most common comorbidities in rheumatoid arthritis (RA) patients, especially patients using glucocorticoids. Bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) is the gold standard of diagnosing and monitoring osteoporosis but does not entirely explain the fracture risk in patients
suffering from systemic inflammatory diseases. A number of fractures are observed in patients with T-scores, which are not in the osteoporotic range. Th is discrepancy may be related to alterations of bone quality and measurements of bone mineral density are overestimated. A challenge in clinical practice is to detect patients with a risk of having fractures although their BMD is in osteopenia. The trabecular bone score (TBS), novel texture parameter reflects degradation of trabecular bone and therefore could be used as another bone measure to predict the risk of fragility fracture. Little is known about the importance of TBS in fracture risk prediction in systemic inflammatory disease and about the influence of biologic treatment on TBS changes. Because the same cytokines are involved in local and systemic bone loss, it is rational to assume that biologics may influence bone turnover and systemic bone loss. Several new studies showed that therapies targeting specific cytokines and its signaling pathways with biologic DMARDs may protect the skeleton but outcomes in these clinical studies were based mostly on bone turnover markers and BMD changes. We compared the effects of biological disease-modifying antirheumatic drugs (bDMARDs) and conventional synthetic (cs) DMARDs (methotrexate) on BMD, bone turnover markers (BTM) and trabecular bone score (TBS) in patients suffering from active RA. Methods: A 12-month prospective trial in 105 active RA patients. Results: Treatment with bDMARDS led to increase of 1.7 % (p<0.05) in TBS but not on BMD. The greatest TBS increase (2.7%, p<0.05) was observed in premenopausal females treates with bDMARDs. No effect of csDMARDS on measured parameters was observed. Based on our observation and literature data TBS could contribute to fracture risk prediction especially in RA patients with osteopenia. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.

Keywords

Hrčak ID:

212198

URI

https://hrcak.srce.hr/212198

Publication date:

5.12.2018.

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