The Relationship of Bone Mineral Density to Oxidant/Antioxidant Status and Inflammatory and Bone Turnover Markers in a Multicenter Cross-Sectional Study of Young Men with Ankylosing Spondylitis

Low bone mineral density (BMD) is an important complication of ankylosing spondylitis (AS) that seriously affects men and their quality of life, even in young patients. However, the relationships among redox; levels of bone turnover markers (BTMs), inflammatory markers and disease activity; and low BMD in AS require clarification. We recruited 102 men aged 30-39 year with AS and 102 healthy, sex- and age-matched controls for this cross-sectional study. The subjects were analyzed for lumbar spine and femoral neck BMD by dual-energy X-ray absorptiometry. Significantly lower BMD and corresponding T-scores were observed in the AS patients compared with the controls (P < 0.05). The oxidant biomarker and antioxidant levels were significantly (P < 0.05) higher and lower, respectively, in the AS subjects compared with the controls, and the bone resorption and inflammatory marker levels were higher (P < 0.05). In subgroup analyses, the patients with osteoporosis or active disease had the highest levels of oxidant biomarkers (P < 0.05). Furthermore, the BMD T-scores in AS were found to be negatively correlated with oxidative status (P < 0.05). Multivariate binary logistic analysis showed that low BMD in the AS patients was associated with higher levels of advanced oxidation protein products, malondialdehyde and C-terminal telopeptide of type I collagen; lower levels of glutathione peroxidase; and higher scores of a bath ankylosing spondylitis metrology index. In conclusion, imbalanced redox was independently associated with low BMD in young men with AS and may play an important role in the pathogenesis of AS-related low BMD.