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Objective: To determine the contribution of vertebral fracture assessment (VFA) using DXA as well as the influence of degenerative changes in the lumbar spine in the interpretation of BMD among patients with psoriatic arthritis (PsA). Methods: The study included 105 patients (52women, 53men ; mean age 57.9±11.2 years) with PsA. BMD measurement and VFA from T4-L4 was performed using aDXAscanner. Diagnosis of vertebral fracture (VF) was based on the Genant semiquantitative classification system. After standard BMD L1-L4 analysis, selected lumbar vertebrae were excluded from the DXA scan according to the recommendations of the International Society of Clinical Densitometry (ISCD). Results: A total of 74 vertebral fractures were detected in 45 (42.8%) patients: 58 grade 1 vertebral fractures, and 16 vertebral fractures of grades 2-3. A total of 64 vertebrae in 42 patients (23 without and 19 with VF) were excluded from the L1-L4 BMD analysis according to the ISCD criteria ; 26 (40.6%) vertebrae at the L4 level. Osteoporosis according to the WHO classification (T-score ≤-2.5 SD) was observed in 11 (10.5%) patients. By the addition of grade 2-3 VFs and exclusion of selected lumbar vertebrae from DXA among patients without osteoporosis, the number of patients considered as osteoporotic increased to 23.8%. BMD values, T-scores, and Z-scores at all measured regions did not differ significantly between patients with (n=45) and without (n=60) VFs. There was neither a significant difference in disease duration nor in the usage of corticosteroids, methotrexate, and sulfasalazine among patients with and without VFs. The higher disability level assessed by the HAQ questionnaire in the group of patients with VFs was significantly associated with lower BMDin the femoral neck and total hip region (p 0.019 and 0.010, respectively). Conclusion: According to our results in patientswith PsA, BMDreportswith consideration of both the results of VFA and vertebral exclusions from L1-L4 DXA applying the ISCD criteria should be included into the evaluation of the disease and thereby give a better insight into the real osteoporosis status. |
