title: The change of bone mineral density according to treatment agents in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  The aim was to access the effects of treatment on bone mineral density (BMD) by treatment agents in patients with ankylosing spondylitis (AS).
  
  
  METHODS
  We analyzed clinical characteristics of 90 AS patients. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and x-ray of lumbar spine (L-spine) and sacroiliac joint were included in the baseline assessment. The BMDs of right femur and L-spine were measured annually using dual x-ray absorptiometry (DXA). The patients were divided into one of the following four groups by agents exposed for the follow-up period: conventional treatment, bisphosphonate, anti-TNF-α agent or bisphosphonate + anti-TNF-α agent. We evaluated the changes of BMD according to treatment groups.
  
  
  RESULTS
  The average age of disease onset was 30 years and the mean disease duration was 8.2 years. The patients who were assigned to the groups of conventional treatment, bisphosphonate, anti-TNF-α agents and bisphosphonate + anti-TNF-α agents were 40, 20, 19 and 11. BMDs values of both L-spine and femur showed tendencies to the most increase in the group treated with concurrent bisphosphonate and anti-TNF-α agent. However, the change of BMD by treatment agents was significant different only in trochanter (P = 0.001). In patients without syndesmophyte, there was significant difference of BMD change in both L-spine and total proximal femur (P = 0.001, 0.004). The BMD change of trochanter was correlated with the reductions of ESR and CRP (r = 0.239, P = 0.035 and r = 0.233, P = 0.040).
  
  
  CONCLUSIONS
  The BMDs of AS patients increased more by the treatment of concurrent bisphosphonate and anti-TNF-α agents. The gain of bone mass was associated with the reduction of inflammation.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Medical College, Chungbuk National University, Cheongju, South Korea. kykang@catholic.ac.kr
authors.forename: Kwi Young
authors.initials: KY
authors.lastname: Kang
authors.forename: Kwan Yong
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kwok
authors.forename: Ji Hyeon
authors.initials: JH
authors.lastname: Ju
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Yeon Sik
authors.initials: YS
authors.lastname: Hong
authors.forename: Ho-Youn
authors.initials: HY
authors.lastname: Kim
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Park
mesh_terms: D015502:Absorptiometry, Photon; D000068879:Adalimumab; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000494:pharmacology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D005269:Femur / Q000503:physiopathology; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology / Q000627:therapeutic use; D000069285:Infliximab; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000503:physiopathology*; D012460:Sulfasalazine / Q000494:pharmacology / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D004164:Diphosphonates; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D012460:Sulfasalazine; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate