Bone Loss in Axial Spondyloarthritis Key to Effective Management Strategies

According to a study published in Seminars in Arthritis and Rheumatism, bone loss plays a significant role in axial spondyloarthritis (axSpA) and highlights the importance of integrating regular assessments and effective management strategies into clinical practice.

Chronic systemic and local inflammation, along with mechanical stress and alterations in the gut microbiome, contribute to bone loss in axSpA. These factors influence osteoclast differentiation and activation via the RANK-RANKL axis while inhibiting osteoblast differentiation through negative regulation of bone anabolic pathways like the Wnt signaling pathway, leading to overall bone loss.

Researchers conducted a comprehensive narrative review to explore the pathogenesis, assessment methods, and management options for axSpA.

Early evaluation at diagnosis is crucial for detecting bone changes in axSpA. Traditional methods like dual x-ray absorptiometry (DXA) have limitations, but alternative techniques such as trabecular bone score (TBS), quantitative CT (QCT), and quantitative ultrasound (QUS) show promise, although their integration into clinical practice remains limited.

In addition to anti-inflammatory drugs, lifestyle modifications such as regular exercise are essential for preserving bone health in axSpA. Tailoring interventions based on individual risk profiles could help mitigate bone loss progression.

“Given the multifaceted contributors to bone loss in axSpA, a multidisciplinary approach is essential,” the authors concluded.

Reference
Nakamura A, Towheed T. Pathogenesis, assessment, and management of bone loss in axial spondyloarthritis. Semin Arthritis Rheum 2024; 64(2);152345. https://doi.org/10.1016/j.semarthrit.2023.152345