Bone mass in axial spondyloarthritis: A literature review

Table 3 Summary of the interventional studies

Ref.	Sample size(M/F)	Mean age	Menopausal statuspre:post	Disease duration(yr)	Dexa machine	Dexa site (coefficientvariation %)	Follow-upduration	Outcome	Conclusion
Allali et al[39]	SpA: 29 (23/6)	35	6:1	13	Hologic	AP L2-4, left PF	6	A significant increase in BMD at the LS, total hip and trochanter is observed in patients with SpA treated with anti-TNF	Benefit of anti-TNFα therapy on BMD in patients with SpA may be through an uncoupling effect on bone cells
Briot et al[37]	SpA: 19 (17/2)	40	NM	16.5	Hologic	L2-4, left FT	12	After 1 yr of treatment BMD increase at the spine and femur total	Treatment with anti-TNFα in SpA is associated with an increase of BMD, which results from a decrease of bone resorption
Biriot et al[41]	SpA: 106 (80/26) AS: 87.8% PsA: 6.6%	38	NM	16.5	Hologic	L2-4, left PF	24	At 1 and 2 yr of treatment, there is a significant gain in BMD at both lumbar spine and PF HLA-B27: 89% Baseline: OP: 28%, osteopenia: 23%	This 2-yr prospective study show a significant increase in BMD, in patients with SpA receiving anti-TNFα treatment
Visvanathan et al[40]	AS: 279 (225/54)	40.3	NM	11.9	NM	L1-4, PF	24	BMD at the spine and hip increase after anti-TNF therapy compared with placebo HLA-B27: 86.7%	Infliximab have positive effect on BMD over 2 yr
Kang et al[34]	AS: 90 (72/18)	29.9 (onset age)	18:0	8.2	Lunar	AP L1-4, right PF	36	The most increase in BMD is observed at the spine and hip in the group treated with concurrent bisphosphonate and anti-TNF HLA-B27: 97% OP: 36.7%	BMD increases more with the combination treatment (bisphosphonate and anti-TNF) and gain of bone mass is associated with the decrease in inflammation
Arends et al[35]	AS: 111 (78/33)	42.2	NM	16	Hologic	AP L1-4, PF	36	LS and hip BMD significiantly increase compared to baseline after anti-TNFα theraphy HLA-B27: 81% LS OP: 9%, openia: 34% TF OP: 2%, openia: 37%	Three years of anti-TNF therapy results increase in bone formation in accordance with the continuous improvement in lumbar spinal BMD
Dischereit et al[38]	RA: 18 (3/15) AS: 16 (9/7)	RA: 62 AS: 48	NM	-	Lunar	AP L2-4 (1.5), FN (2)	24	At baseline in AS, osteopenia: 50% and OP: 6.3% A stable peripheral BMD, significant increases in axial BMD, could be observed after 24 mo of anti-TNFα therapy compared with baseline	Anti-TNF therapy has favorable effects over osteoprotective pathways in patients with AS and RA
Kang et al[36]	AS: 63 (52/11)	36.8	11:2	8.6	Prodigy	L1-4, right PF	24	BMD at LS and FT of patients receiving anti-TNF increase regularly over 2 yr TNF blocking therapy and the increase in SASSS are independently associated with increased BMD at lumbar spine HLA-B27: 87%	TNF inhibitors appear to be associated with increased SASSS scores and improvements in BMD

BMD: Bone mineral density; F: Female; M: Male; FN: Femur neck; FT: Femur total; NM: Not mentioned; PF: Proximal femur; TNF: Tumor necrosing factor; SpA: Spondyloarthritis; AS: Ankylosing spondylitis; SASSS: Stoke Ankylosing spondylitis spine score; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; TF: Total femur; OP: Osteoporosis; HLA: Human leukocyte antigen; LS: Lumbar spine.