Osteoporosis Management in Ankylosing Spondylitis

Area of Science:

• Rheumatology
• Endocrinology
• Orthopedics

Background:

• Low bone mineral density (BMD) is a frequent comorbidity in ankylosing spondylitis (AS).
• Patients with AS face an elevated risk of fractures compared to the general population.
• Low BMD can manifest early in the course of AS.

Purpose of the Study:

• To outline a strategy for identifying and managing low BMD in patients diagnosed with AS.
• To emphasize the importance of early intervention to mitigate fracture risk.

Main Methods:

• Screening for low BMD using dual-energy x-ray absorptiometry (DXA) within the first year of AS diagnosis.
• Initiating bisphosphonate therapy for osteoporosis (T-score < -2.5 or Z-score < -2.0).
• Considering denosumab for contraindications to bisphosphonates and TNF-alpha inhibitors (TNFi) for active disease with positive BMD effects.

Main Results:

• Bisphosphonates are the first-line treatment, leveraging established efficacy in primary osteoporosis.
• Denosumab serves as an alternative therapy when bisphosphonates are contraindicated.
• Early initiation of TNFi is favored for active AS patients not already on therapy, noting potential BMD benefits.

Conclusions:

• A proactive approach involving early DXA screening and targeted pharmacotherapy is crucial for managing low BMD in AS.
• Lifestyle modifications, including adequate vitamin D/calcium intake and weight-bearing exercises, are essential components of care.
• While fracture risk reduction with specific treatments in AS requires further definition, current strategies aim to prevent fractures based on established osteoporosis guidelines.