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BMD improved with etanercept in patients with AS, but fracture risk remained
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Patients with ankylosing spondylitis had improvements in bone mineral density after treatment with etanercept, but the risk for fracture remained high, according to researchers at the Jan van Breemen Research Institute/Reade in Amsterdam.
A group of 49 patients with ankylosing spondylitis were enrolled at initiation of etanercept (Enbrel, Amgen). All patients were naïve to other biologic treatments. Overall, 82% of patients were men. Patients had a mean age of 42 years, a mean disease duration of 12.2 years and a mean follow-up of 2.3 years. Disease activity was high prior to treatment, and three patients had bilateral total hip replacements at inclusion. All patients underwent dual X-ray absorption (DXA) spinal scans, and the 46 patients without hip replacements underwent hip DXA scans. Osteoporosis was present in 12% of patients at baseline, and 45% had osteopenia.
Following 2 years of treatment with etanercept, 4% of patients had osteoporosis and 41% had osteopenia. Hip bone mineral density (BMD) increased by 2.2% after 2 years and lumbar spine BMD increased by 7%.
At baseline, at least one vertebral fracture was present in 12.2% of patients (n = 6). Following treatment with etanercept for 2 years, 30.6% of patients (n = 15) had one or more vertebral fractures, all of which were wedge deformities. Most fractures were localized in the mid-thoracic spine. The severity increased from four of eight fractures at baseline graded 2 or higher to 13 fractures graded 2 or higher at 2 years. No studied variables, such as age, BMD, disease activity, radiologic progression or other data, correlated with the number of fractures or severity. – by Shirley Pulawski
Disclosure: This investigator-initiated cohort study was financed by an unrestricted grant from Pfizer.
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