{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T22:40:38Z","timestamp":1759963238280,"version":"3.44.0"},"reference-count":33,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2020,11,13]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate if in radiographic axial Spondyloarthritis (r-axSpA) low vertebral bone mineral density (BMD) is associated with development of new syndesmophytes at the same vertebral level.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a post-hoc analysis from the ASSERT trial (infliximab vs placebo), dual-energy X-ray absorptiometry was used to measure baseline BMD (g\/cm<jats:sup>2<\/jats:sup>) of the lumbar spine L1 to L4. Syndesmophyte formation was assessed in the same vertebrae on conventional radiographs defined as an increase in modified Stoke Ankylosing Spondylitis Spine Score from 0 or 1 to 2 or 3 after 2 years. Radiographs were scored by two readers. Generalised estimating equations (GEE) adjusted for within-patient correlation across multiple vertebrae, taking potential confounders into account.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s3\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We analysed 599 vertebrae in 165\u00a0r-axSpA patients (78% male, mean (SD) age 38 (10) years, 67% with at least one syndesmophyte anywhere in the spine). In total, 24 to 74 new syndesmophytes developed in 9 (5%) to 30 (18%) patients and 13 (2%) to 39 (7%) vertebrae, if either a syndesmophyte was seen by both or only one of the readers (ie, specific and sensitive definitions) respectively. In multivariable analyses, no association was found between baseline local vertebral BMD and new syndesmophyte formation after 2 years: adjOR (95% CI): 0.56 (0.01, 44.45) (specific definition) and 0.26 (0.03, 2.63) (sensitive definition).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"s4\">\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with active and established r-axSpA, with an observed low incidence of lumbar spine syndesmophyte formation over 2 years, no relationship was found between baseline BMD and new radiographic syndesmophyte formation at the same vertebra.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2020-001391","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T05:32:06Z","timestamp":1607664726000},"page":"e001391","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["No relationship between bone mineral density and syndesmophyte formation at the same level in the lumbar spine of patients with radiographic axial Spondyloarthritis"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-9425","authenticated-orcid":false,"given":"Mary Lucy","family":"Marques","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands"},{"name":"Department of Rheumatology, Centro Hospitalar E Universitario De Coimbra EPE, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Ramiro","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands"},{"name":"Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-7972","authenticated-orcid":false,"given":"Pedro M","family":"Machado","sequence":"additional","affiliation":[{"name":"Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK"},{"name":"Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5781-158X","authenticated-orcid":false,"given":"Desir\u00e9e","family":"van der Heijde","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8448-7407","authenticated-orcid":false,"given":"Floris A","family":"van Gaalen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,11]]},"reference":[{"key":"2025090313300350000_6.3.e001391.1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.091793"},{"key":"2025090313300350000_6.3.e001391.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.124206"},{"key":"2025090313300350000_6.3.e001391.3","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s11914-011-0058-z","article-title":"Osteoporosis: a paradox in ankylosing spondylitis","volume":"9","author":"Carter","year":"2011","journal-title":"Curr Osteoporos Rep"},{"key":"2025090313300350000_6.3.e001391.4","doi-asserted-by":"crossref","DOI":"10.1186\/ar3833","article-title":"Osteoporosis in ankylosing spondylitis - 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A new approach to defining disease status in ankylosing spondylitis: the bath ankylosing spondylitis disease activity index. J Rheumatol 1994;21:2286\u201391. PMID: 7699630."},{"key":"2025090313300350000_6.3.e001391.16","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2004.020503"},{"key":"2025090313300350000_6.3.e001391.17","doi-asserted-by":"publisher","DOI":"10.1002\/art.20446"},{"key":"2025090313300350000_6.3.e001391.18","unstructured":"TJ WR . Applied longitudinal data analysis for epidemiology: a practical guide . 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