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Theresa Huddleston

Professor Don Larson 

Biology 111

22 July 2024

Correlation of Ankylosing Spondylitis and Bone Mineral Density and Possible Effective Treatments:

For my steam project, I chose to explore the bones regarding a disease called Ankylosing Spondylitis (AS). It will cover the objectives of functions of bones as well as bone development and repair by looking at the effects of bone deterioration linking osteoporosis to AS. Ankylosing spondylitis is a chronic inflammatory disease that mainly affects the sacroiliac joints and spine. This disease can impact an individual’s daily quality of life and cause many symptoms including: lower back pain and stiffness (commonly first thing in the morning or due to inactivity), hip pain, difficulty bending the spine, difficulty walking, and chest pain. These symptoms are a result of inflammation and in advances cases of AS, fusion of the joints will take place. [4]

            Many studies done of AS have been reported, so a healthy background of this disease is important. Ankylosing spondylitis tends to be more prevalent in males than in females. [4] Most patients presented with AS are also born with a particular gene called HLA-B27. [4] This gene puts the individual at a higher risk of developing a spondyloarthropathy, which is the family of disease of arthritis. Although the AS can begin in young individuals, it is generally not detected or diagnosed until later in life. 

            With AS, bone loss will generally take place resulting in low bone mineral density (BMD). This is detected through dual-energy X-ray absorptiometry (DXA), or MRI’s. The results of these images will show inflammatory lesions. They usually appear along the lower thoracic spine; however, they may appear in the upper thoracic spine, lumbar spine, sacroiliac joints, hip joints and sternoclavicular joints. These inflammatory lesions detect the loss of BMD. [1,2,3]

            The findings in one study done by the International League of Associations for Rheumatology suggests that patients with AS had poor bone microarchitecture as well as low bone mass than healthy individuals. Although bone loss due to the progression of AS is a continued clinical phenomenon and still unclear, there is evidence that inflammation plays a role in the loss of BMD. Low BMD usually results in developing osteoporosis. This is a condition where osteoclasts (a bone cell that breaks down old bone tissue) are active and osteoblasts (a bone cell that creates new bone tissue) are inhibited. [1]

            Treatment for AS with osteoporosis is not well established. In a study done by Chungbuk National University in South Korea and The Catholic University of Korea found that using anti-TNF-α agents (antitumor necrosis factor; medication including Infliximab, Etanercept and Adalimumab) in tandem with bisphosphonates (used to treat osteoporosis) showed increases to overall bone mineral density in the study’s patients. The study also suggested a relationship between gain of bone mass with inflammation activity being reduced in these same patients. [2]

            The overall findings of these studies suggest that inflammatory activity was greatly associated with significant bone mass loss in patients with AS. However, treatments of anti-TNF-α agents combined with bisphosphonates can increase the BMD of individuals suffering from Ankylosing Spondylitis. Moreover, systematic control of inflammation may be a large factor as well in the treatment of osteoporosis in AS to help reduce further bone mass loss. 

            I have provided a collage of various individuals with AS to show inflammatory lesions in different areas of the spine and hips to further your understanding of the effects of this disease on bones. Ankylosing Spondylitis can be a crippling disease that can decrease the quality of life for those affected. Early detection and treatment of inflammation are key to living a comfortable and healthy life for those affected. 

References:

  1. Kim, J. W., Chung, M. K., Lee, J., Kwok, S. K., Kim, W. U., Park, S. H., & Ju, J. H. (2019). Low bone mineral density of vertebral lateral projections can predict spinal radiographic damage in patients with ankylosing spondylitis. Clinical Rheumatology, 38(12), 3567–3574. https://doi.org/10.1007/s10067-019-04743-7
  2. Kang, K. Y., Lee, K. Y., Kwok, S. K., Ju, J. H., Park, K. S., Hong, Y. S., Kim, H. Y., Park, S. H. (2010). The change of bone mineral density according to treatment agents in patients with ankylosing spondylitis. Elsevier Masson, 78(2011), 188-193. https://www.sciencedirect.com/science/article/abs/pii/S1297319X1000165X
  3. Weber, U., Pfirrmann, C. W., Kissling, R. O., Hodler, J., & Zanetti, M. (2007). Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC musculoskeletal disorders, 8, 20. https://doi.org/10.1186/1471-2474-8-20
  4. Norman, J. C., PhD. (2024). Spondylitis. Salem Press Encyclopedia of Health. https://research-ebsco-com.uaf.idm.oclc.org/c/qg64q2/viewer/html/5vfcrrcs3b?auth-callid=e6818241-cc6a-9615-9997-bc358ad852f7
AS-Steam-Project