Background/Purpose: To assess the 2-year bone mineral density (BMD) changes at lumbar spine and hip in a large cohort of patients with early inflammatory back pain (IBP) suggestive of axial Spondyloarthritis (SpA), and to assess determinants of bone loss.

Methods: of the 708 patients of the DESIR cohort (IBP of less than 3 years duration suggestive of axial SpA), 265 (54% males, mean age 34.4 years) had BMD measurements at baseline and 2 years. Low BMD was defined as Z score ≤-2 (at at least one site) and significant bone loss was defined by a decrease in BMD≥0.03g/cm². Clinical, biological (erythrocyte sedimentation rate ESR and C reactive protein CRP, bone formation inhibitors markers (sclerostin and DKK-1 serum levels)), imaging (X-rays, spine and sacroiliac joints MRI) parameters and therapies were assessed. AntiTNF users were defined as those who received antiTNF at 2 years. The dependant variable of this study was the bone loss (decrease in BMD> 0.03 g/cm2) at either lumbar spine or hip site. Independant variables included both the ones collected at baseline (age, gender, BMI, BASDAI, ADSAS CRP, ESR, CRP, HLA B27, current use of NSAIDS use, ASAS NSAIDs score, X-rays sacroiliitis, bone marrow oedema on sacroiliac or spine MRI, lean and fat masses, sclerostin and DKK-1) and 2-year longitudinal variables (BMI, BASDAI, ADSAS CRP, ESR, CRP, current NSAIDS use, ASAS NSAIDs score, lean and fat masses, intake of antiTNF). Parameters were tested in univariate and multivariate analyses; accuracy of models was measured by the area under the curve (AUC).

Results: Thirty nine patients (14.7%) patients had low BMD at baseline. 2-year BMD significantly changed from baseline at lumbar spine (+1.3 (6.4) %, p=0.02) and total hip (-0.3 (4.0) %, p=0.02). 95 patients (35.8%) had a 2-year significant bone loss (at lumbar spine or hip), 59 (22.4%) at lumbar spine and 46 (18.0%) at total hip. 187 (70.6%) had current use of NSAIDS  at baseline and 89 (33.6%) received anti-TNF at 2 years (mean duration 5.7 (9.1) months). Significant 2-year lumbar spine bone loss was associated in multivariate analysis with age (OR=1.06 (1.00 – 1.12), p=0.017) (AUC= 0.608). In multivariate analysis, current use of NSAIDS at baseline (OR=0.38 (0.19–0.76), p=0.006) had a protective effect on hip bone loss (AUC= 0.608). In patients without anti-TNF treatments at 2 years (n=176): male gender was the only predictor of lumbar spine bone loss (OR= 2.4 (1.13-5.09), p=0.023) (AUC= 0.608). In these patients, current use of NSAIDS (OR= 0.09 (0.02 – 0.5), p= 0.006) and 2-year increase in BMI (OR= 0.55 (0.37-0.85), p=0.003) had protective effects on hip bone loss whereas 2-year increase in fat mass was associated with hip bone loss (OR=1.18 (1.02-1.42), p=0.046) (AUC=0.833).

Conclusion: Among patients with early IBP among whom a third received antiTNF during the follow-up, BMD are in the normal range and 35% have significant bone loss over 2 years. Current use of NSAIDS has a protective effect on hip bone loss in patients with or without antiTNF.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-non-steroidal-anti-inflammatory-drugs-prevent-bone-loss-in-patients-with-early-inflammatory-back-pain-results-from-the-desir-cohort/