Low Osteoporosis Screening Rates in Ankylosing Spondylitis Registry of Ireland (ASRI) Cohort
Fitzgerald G1, Gallagher P2, O Sullivan C3, O Rourke K4, Sheehy C5, Stafford F6, Silke C7, Haroon M8, Lundon DJ9, Mullan R10, FitzGerald O2, O Shea F1.
1St James’s Hospital
2St Vincent’s Hospital
3Galway University Hospital
4Midlands Regional Hospital Tullamore
5University Hospital Waterford
7Sligo General Hospital
8Kerry General Hospital
9University College Dublin
Osteoporosis is a complication of Ankylosing Spondylitis (AS)1 and international recommendations state that these patients should be assessed for low bone mineral density (BMD)2.
The AS Registry of Ireland (ASRI) provides descriptive epidemiological data on the Irish AS population. The aim of this study was to explore the prevalence of low BMD and screening by dual-energy x-ray absorptiometry (DXA) in an AS patient cohort.
A standardised clinical assessment was performed on each patient and structured interviews provided patient-reported data. Patients were categorised by the presence or absence of DXA testing and further subcategorised by T score into normal page 54 BMD, osteopoenia or osteoporosis. Statistical analysis was performed using SPSS.
As of June 2015, 340 patients have been included in ASRI (79.7% males; mean age 47.6 (SD 12.6); mean disease duration 21.6 years (SD 12); average delay to diagnosis of 8.9 years (SD 8.5)). Mean BASDAI was 3.9 (SD 2.4), BASFI 3.8 (SD 2.6) and HAQ 0.56 (SD 0.52).Self-reported prevalence of osteoporosis was 7.4%. 25% of the population had DXAs performed. Of these, 52.9% had normal BMD, 30.6% had osteopenia and 16.5% had osteoporosis. Older patients and men were more likely to have both osteopenia and osteoporosis (p<0.05). Patients were more likely to have a DXA with longer disease duration (p<0.001), older age group (p<0.001), higher functional disability (p<0.05) and the presence of hypertension (p<0.001).
Osteoporosis screening rates are low in this study. Of those screened, there is a high prevalence of both osteopoenia and osteoporosis, raising concerns that osteoporosis is underdiagnosed in this cohort. This is one of few studies looking at osteoporosis screening in AS patients. Education plans for health care professionals and patients need to be improved.
1. Karberg K, Zochling J, Sieper J, et al. Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. J Rheumatol 2005;32:1290-8.
2. Braun J,van der Berg R, Baraliakos X, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011 Jun;70(6):896- 904.