Study of vertebral fracture and Scanographic Bone Attenuation Coefficient in rheumatoid arthritis and ankylosing spondylitis vs. controls

Marine Fauny, Eliane Albuisson, Elodie Bauer, Julia Perrier-Cornet, Isabelle Chary-Valckenaere, Damien Loeuille, Marine Fauny, Eliane Albuisson, Elodie Bauer, Julia Perrier-Cornet, Isabelle Chary-Valckenaere, Damien Loeuille

Abstract

The objective of this study is to identify the prevalence of vertebral fractures (VFs) and to measure the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) based CT-scan, a biomarker of bone fragility in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and in a control group. This monocentric and retrospective study included patients with RA and AS, based on ACR/EULAR or New-York criteria, respectively. A control group was constituted. All of the patients received a CT-scan. VFs were determined via CT-scans according to the Genant classification, and the SBAC-L1 was measured in Hounsfield units (HU). SBAC-L1 ≤145 HU (fracture threshold) defined patients at risk of VFs. 244 patients were included (105 RA, 83 AS, 56 controls). Of the 4.365 vertebrae studied, 66 osteoporotic VFs were found in 36 patients: 18 (17.1%) RA, 13 (15.7%) AS and 5 (8.9%) controls. The mean SBAC-L1 was 142.2 (±48.4) HU for RA, 142.8 (±48.2) for AS, both of which were significantly lower than that of the control group (161.8 (±42.7) HU). Of the 36 patients with VFs and rheumatism, 28% had a T-score ≤-2.5 SD and 71.4% a SBAC-L1 ≤145 HU. A T-score ≤-2.5 SD and a SBAC-L1 ≤145 HU were associated with VF (OR = 3.07 (CI 95%: 1.07; 8.81), and 2.31 (CI 95%: 1.06; 5.06)), respectively. The SBAC-L1 was significantly lower in the RA and AS groups than in the control group. Furthermore, SBAC-L1 ≤145 HU was associated with a higher risk of VFs, with an odds ratio similar to that of a DXA.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Spine DXA examples. (A) Spine DXA from patients without lumbar spine involvement. (B) Spine DXA from patient with osteophytes in L2 and L3 responsible for increase of spine mineral density on spine DXA. (C,D) DXA from patients with ankylosed spine, source of misinterpretation for DXA spine results.
Figure 2
Figure 2
Flow chart for the group RA (A) and AS (B) AS: ankylosing spondylitis, RA: Rheumatoid Arthritis; CT: Computed Tomography.
Figure 3
Figure 3
VFs grade (Genant classification) (A) and location (B) according to the different groups. AS: ankylosing spondylitis, RA: Rheumatoid Arthritis. T: Thoracic vertebra, L: Lumbar vertebra.
Figure 4
Figure 4
Spine T-score (A) and SBAC-L1 (B) distribution of the patients with VFs for the different groups. The black circle represents the grade 1 VFs. (A) The red line stands for the threshold of −2.5 SD, the definition of osteoporosis on DEXA. (B) The red line stands for the fracture threshold of 145 HU. Note that patient no. 7 did not have an available SBAC-L1. AS: Ankylosing spondylitis, RA: Rheumatoid Arthritis. VF: Vertebral Fracture, SBAC-L1: Scanographic Bone Attenuation Coefficient of the first lumbar vertebra, HU: Hounsfield Unit, DEXA: Dual Energy X-ray Absorptiometry.

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