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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Factors associated with bone mineral density loss in patients with spondyloarthropathies: A 4-year follow-up study

Centre of Family Medicine, Vilnius University, Vilnius, Lithuania
Centre of Rheumatology, Vilnius University, Vilnius, Lithuania
Centre for Innovative Medicine, State Research Institute, Vilnius, Lithuania
Centre of Traumatology, Orthopedics and Plastic and Reconstructive Surgery, Vilnius University, Vilnius, Lithuania
Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania
Centre of Internal Medicine, Vilnius University, Vilnius, Lithuania
Author to whom correspondence should be addressed.
Medicina 2015, 51(5), 272-279;
Received: 11 November 2014 / Revised: 28 July 2015 / Accepted: 9 August 2015 / Published: 9 September 2015
Objective: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs).
Methods: A cohort of 41 SpA patients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, BMD using were monitored at the baseline and 4-year follow-up. The 4% BMD loss at either of the proximal femurs was defined as significant.
Results: Over the 4-year study period, 27% of SpA patients experienced femoral BMD loss. Baseline BMD > 0.85 g/cm2 (p = 0.011) was the baseline factor associated with BMD loss at 4- year follow-up. Several clinical and functional tests were helpful in identifying the BMD loss at follow-up: CRP > 15.6 mg/L (sens. 91%, spec. 70%), ESR > 29 mm/h (sens. 82%, spec. 73%), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) > 4.75 (sens. 91%, spec. 62%). At follow-up anti-TNFa treatment history, stable or improved lateral flexion and intermalleolar distance (NPV, accordingly, 95%, 88% and 87%), made BMD loss unlikely. Deterioration of the physician assessment of global disease activity (PAGDA) score from baseline to follow-up was a remarkable predictor of BMD loss (PPV = 0.83), while stable or improved score excluded the BMD loss (NPV = 0.83). According to multiple logistic regression analysis, baseline BMD value and follow-up CRP levels, when considered together, identify BMD status correctly in 85% of SpA patients (Nagelkerke R2 = 0.676).
Conclusion: Baseline BMD, anti-TNFa treatment, PAGDA score, spinal mobility tests and disease activity markers are useful factors in predicting the BMD loss in SpA patients and can provide surrogate information on BMD status.
Keywords: Spondyloarthropathies; Bone mineral density; Anti-TNFa Spondyloarthropathies; Bone mineral density; Anti-TNFa
MDPI and ACS Style

Vencevičienė, L.; Butrimienė, I.; Vencevičius, R.; Sadauskienė, E.; Kasiulevičius, V.; Šapoka, V. Factors associated with bone mineral density loss in patients with spondyloarthropathies: A 4-year follow-up study. Medicina 2015, 51, 272-279.

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