Osteoimmunology and osteoporosis |
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Authors: | Piet Geusens Willem F Lems |
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Institution: | Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P, Debyelaan 25 Postbus 5800, 6202 AZ Maastricht, The Netherlands. piet.geusens@scarlet.be |
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Abstract: | The concept of osteoimmunology is based on growing insight into the links between the immune system and bone at the anatomical,
vascular, cellular, and molecular levels. In both rheumatoid arthritis (RA) and ankylosing spondylitis (AS), bone is a target
of inflammation. Activated immune cells at sites of inflammation produce a wide spectrum of cytokines in favor of increased
bone resorption in RA and AS, resulting in bone erosions, osteitis, and peri-inflammatory and systemic bone loss. Peri-inflammatory
bone formation is impaired in RA, resulting in non-healing of erosions, and this allows a local vicious circle of inflammation
between synovitis, osteitis, and local bone loss. In contrast, peri-inflammatory bone formation is increased in AS, resulting
in healing of erosions, ossifying enthesitis, and potential ankylosis of sacroiliac joints and intervertebral connections,
and this changes the biomechanical competence of the spine. These changes in bone remodeling and structure contribute to the
increased risk of vertebral fractures (in RA and AS) and non-vertebral fractures (in RA), and this risk is related to severity
of disease and is independent of and superimposed on background fracture risk. Identifying patients who have RA and AS and
are at high fracture risk and considering fracture prevention are, therefore, advocated in guidelines. Local peri-inflammatory
bone loss and osteitis occur early and precede and predict erosive bone destruction in RA and AS and syndesmophytes in AS,
which can occur despite clinically detectable inflammation (the so-called 'disconnection'). With the availability of new techniques
to evaluate peri-inflammatory bone loss, osteitis, and erosions, peri-inflammatory bone changes are an exciting field for
further research in the context of osteoimmunology. |
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