title: Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis: results from the prospective DESIR cohort.
abstract: OBJECTIVE
  The objectives of the study were to assess the 2 year BMD changes and their determinants in patients with early inflammatory back pain suggestive of axial spondyloarthritis (SpA) (DESIR cohort).
  
  
  METHODS
  A total of 265 patients (54% male, mean age 34.4 years) had BMD measurements at baseline and at 2 years. Low BMD was defined as a Z score ≤-2 (at at least one site) and significant bone loss was defined by a decrease in BMD ≥0.03 g/cm(2). Clinical, biological and imaging parameters were assessed over 2 years.
  
  
  RESULTS
  Thirty-nine patients (14.7%) had low BMD at baseline; 112 patients (42.3%) had a 2 year significant bone loss. One hundred and eighty-seven (70.6%) used NSAIDs at baseline and 89 (33.6%) received anti-TNF therapy over 2 years. In anti-TNF users, BMD significantly increased at the lumbar spine and did not change at the hip site from baseline. In multivariate analysis, baseline use of NSAIDs [odds ratio (OR) 0.38, P = 0.006] had a protective effect on hip bone loss. In patients without anti-TNF treatments, baseline use of NSAIDs (OR 0.09, P = 0.006) and a 2 year increase in BMI (OR 0.55, P = 0.003) had protective effects on hip bone loss, whereas a 2 year increase in fat mass was associated with hip bone loss (OR 1.18, P = 0.046).
  
  
  CONCLUSIONS
  Among patients with symptoms suggestive of early axial SpA, 42.3% of patients have significant bone loss over 2 years. Anti-TNF therapy is protective against bone loss and baseline use of NSAIDs has a protective effect on hip bone loss.
authors.affiliation: Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and karine.briot@aphp.fr.
authors.forename: Karine
authors.initials: K
authors.lastname: Briot
authors.affiliation: Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and.
authors.forename: Adrien
authors.initials: A
authors.lastname: Etcheto
authors.affiliation: Paris-Sud University, Bicêtre Hospital, Rheumatology Department, Le Kremlin Bicêtre, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Miceli-Richard
authors.affiliation: Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and.
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001416:Back Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D025241:Spondylarthritis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: bone; bone mineral density; epidemiology; non-steroidal anti-inflammatory drugs; spondyloarthritis