Bone oedema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort

Ann Rheum Dis. 2013 Dec;72(12):1914-9. doi: 10.1136/annrheumdis-2012-201845. Epub 2012 Nov 17.


Objectives: To assess bone mineral density (BMD) 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 systemic and bone inflammation (according to MRI) as risk factors of low BMD.

Patients and methods: 332 (52.4% male) patients with IBP suggestive of axial SpA defined by Calin or Berlin criteria were recruited; they had lumbar spine and hip BMD and body composition measurements. Low BMD was defined by Z≤-2 (at least one site). Clinical, biological (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and imaging (x-rays, spine and sacroiliac joint MRI) parameters were compared in patients with and without low BMD (Z≤-2). Significant parameters in univariate analysis were tested in multivariate models.

Results: Patients (mean age 33.8 years) had a short duration of axial symptoms (mean 1.6 years); 71.4% fulfilled the Assessment of Spondyloarthritis International Society criteria for axial SpA and HLA-B27 was present in 62.1%. 43 (13.0%) had low BMD (88% male). Multivariate logistic regression showed that parameters significantly associated with low BMD (any site) were the presence of bone marrow oedema (inflammatory lesions) on MRI (OR 4.63, p=0.001), either ESR or CRP (OR 2.60, p=0.037) and male gender (OR 9.60, p=0.0004).

Conclusions: This study conducted in a large cohort of young adults with early IBP suggestive of SpA shows that 13.0% of patients have a low BMD and that the main risk factor associated with low BMD was inflammation on MRI.

Keywords: Bone Mineral Density; Osteoporosis; Spondyloarthritis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods
  • Adolescent
  • Adult
  • Back Pain / epidemiology
  • Back Pain / etiology*
  • Back Pain / physiopathology
  • Blood Sedimentation
  • Bone Density / physiology
  • Bone Diseases / complications
  • Bone Diseases / diagnosis
  • Bone Diseases / epidemiology
  • Bone Diseases / physiopathology
  • C-Reactive Protein / metabolism
  • Cohort Studies
  • Edema / complications*
  • Edema / diagnosis
  • Edema / epidemiology
  • Edema / physiopathology
  • Female
  • France / epidemiology
  • Hip Joint / physiopathology
  • Humans
  • Lumbar Vertebrae / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Osteoporosis / diagnosis
  • Osteoporosis / epidemiology
  • Osteoporosis / etiology*
  • Osteoporosis / physiopathology
  • Risk Factors
  • Spondylarthritis / complications*
  • Spondylarthritis / epidemiology
  • Spondylarthritis / physiopathology
  • Young Adult


  • C-Reactive Protein