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Inicio Medicina Clínica (English Edition) The risk of osteoporosis in patients with ankylosing spondylitis—A large retro...
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Vol. 160. Issue 9.
Pages 373-378 (May 2023)
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Vol. 160. Issue 9.
Pages 373-378 (May 2023)
Original article
The risk of osteoporosis in patients with ankylosing spondylitis—A large retrospective matched cohort study
El riesgo de osteoporosis en pacientes con espondilitis anquilosante: un estudio retrospectivo de cohortes emparejadas
Kassem Sharifa,b,c, Avishai M. Tsurb,c,d,e, Niv Ben-Shabatb,c, Abdulla Watadb,c,f, Arnon D. Coheng,h, Howard Amitalb,c,
Corresponding author
a Department of Gastroenterology, Sheba Medical Centre, Tel-Hashomer, Israel
b Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5262100 Tel-Hashomer, Israel
c Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
d Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
e Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
f Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
g Chief Physicians Office, Clalit Health Services, Tel Aviv, Israel
h Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
Article information
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Figures (2)
Tables (3)
Table 1. Basic characteristics of the cohort.
Table 2. Basic characteristics of the cohort stratified by sex.
Table 3. The association of ankylosing spondylitis and osteoporosis in fully adjusted Cox model.
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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:
Osteoporosis
Ankylosing spondylitis
Epidemiology
Primary care
Resumen
Antecedentes

La espondilitis anquilosante (EA) se asocia a un aumento del recambio óseo y de la inflamación sistémica. La osteoporosis es común pero frecuentemente subestimada en la EA: los estudios sobre la incidencia de la osteoporosis en la EA son limitados y se basan en cohortes pequeñas. El objetivo de este estudio es evaluar el riesgo de osteoporosis en pacientes con EA en comparación con controles emparejados.

Métodos

Estudio de cohorte retrospectivo basado en la población utilizando datos recuperados de un gran registro médico electrónico en Israel, los servicios de salud Clalit. Se incluyeron pacientes a los que se les diagnosticó EA desde enero de 2002 hasta diciembre de 2018 y se les hizo un seguimiento para el desarrollo de osteoporosis. Se comparó la incidencia de osteoporosis entre los pacientes con EA y los controles y se utilizó un modelo de regresión logística para evaluar la interacción entre la EA y la osteoporosis.

Resultados

El estudio incluyó a 5.476 pacientes con EA y a 2.7657 controles emparejados por edad y sexo. La incidencia de osteoporosis en los pacientes con EA fue significativamente mayor que en los controles (4,7% frente a 2,8%; p<0,001) en toda la cohorte, así como cuando se estratificó por sexo. La osteoporosis se desarrolló antes en los pacientes con EA frente a los controles (4,1 frente a 5,2años; p<0,001). En el análisis multivariado y tras ajustar varios posibles factores de confusión, se observó que la EA se asociaba de forma independiente con la osteoporosis (HR: 1,83; IC95%: 1,58-2,11; p<0,0001).

Conclusiones

Nuestro estudio confirma la existencia de mayor incidencia y el desarrollo más temprano de la osteoporosis en pacientes con EA. Este hallazgo pone de manifiesto la necesidad de una mayor concienciación y una detección más temprana de esta comorbilidad, lo que permitirá un tratamiento rápido para evitar secuelas no deseadas, como el aumento del riesgo de fracturas.

Palabras clave:
Osteoporosis
Espondilitis anquilosante
Epidemiología
Atención primaria

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