Can Ankylosing Spondylitis Lead to Rapid Osteoporosis in Young Patients?

Can ankylosing spondylitis lead to osteoporosis so quickly?

Dear Dr.
Tseng,
I am currently 19 years old and have been diagnosed with ankylosing spondylitis for 2.8 years, with symptoms limited to pain in the buttocks.
For the first 1.5 years, I was unaware that it was ankylosing spondylitis, so I was treated with physical therapy.
In the following year, I primarily took Celebrex, which provided some improvement, but not completely (my CRP levels decreased from 1.8 mg/dL before medication to between 0.9 and 0.4, while my ESR fluctuated between 15 and 40.
Although the buttock pain has improved, it is still not fully resolved).
In the past two months, I switched to Salazopyrin, and my condition has been almost well-controlled.
I would like to ask you, Dr.
Tseng:
1) Generally speaking, considering my current age, the duration of my illness, and my treatment status, what is the likelihood that I have developed osteoporosis due to ankylosing spondylitis? In other words, do individuals with ankylosing spondylitis typically experience osteoporosis at such an early stage?
2) I currently take Salazopyrin after breakfast and dinner, but I often lack appetite in the morning and skip breakfast.
Is it acceptable to only drink milk in the morning and then take Salazopyrin?
Thank you, Doctor.

Hao, 20~29 year old female. Ask Date: 2023/01/11

Dr. Zeng Guosen reply Internal Medicine

1.
Ankylosing spondylitis is not a significant factor leading to osteoporosis; as long as it is well-controlled and stable, it generally does not cause bone loss.
2.
If you are taking Salazopyrin, you can take two tablets at once after dinner if you are only taking one tablet in the morning and one in the evening.
Thank you.

Reply Date: 2023/01/11

More Info

Ankylosing Spondylitis (AS) is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. It can also have systemic effects, including the potential for osteoporosis, particularly in younger patients. Your concerns regarding the risk of developing osteoporosis at a young age due to AS are valid and warrant a detailed discussion.

1) Risk of Osteoporosis in Young Patients with AS: The risk of developing osteoporosis in young patients with ankylosing spondylitis can be influenced by several factors, including disease activity, duration of the disease, and treatment regimen. In general, AS can lead to bone loss due to chronic inflammation, which can disrupt the normal balance of bone remodeling. Inflammation can stimulate osteoclast activity (cells that break down bone), leading to increased bone resorption and, consequently, a decrease in bone density.

In your case, having AS for 2.8 years, especially during a critical period of growth and development, does raise concerns about bone health. However, the degree of risk varies among individuals. Factors such as the effectiveness of your treatment, your level of physical activity, nutritional intake (especially calcium and vitamin D), and the presence of other risk factors (like smoking or excessive alcohol consumption) play significant roles in determining your bone health.

Studies suggest that while young patients with AS can be at risk for osteoporosis, the extent and speed of bone density loss can vary. Early diagnosis and effective management of AS, including the use of anti-inflammatory medications and physical therapy, can help mitigate this risk. Regular monitoring of bone density through dual-energy X-ray absorptiometry (DEXA) scans may be advisable, especially if you have other risk factors for osteoporosis.

2) Medication Administration with Food: Regarding your question about taking your medication (Salazopyrin) without breakfast, it is generally recommended to take medications with food to enhance absorption and reduce gastrointestinal side effects. Salazopyrin (sulfasalazine) is often taken with meals to improve its efficacy and minimize potential stomach upset. If you find it difficult to eat breakfast, consuming a light meal or snack that includes some carbohydrates and protein can be beneficial. Drinking milk alone may not provide the necessary nutrients to optimize the absorption of your medication.

If you are unable to eat a full breakfast, consider having a small meal or a nutritious snack that can help facilitate the absorption of your medication. You might also want to discuss this with your healthcare provider, as they can provide personalized advice based on your specific situation and dietary habits.

In conclusion, while there is a potential risk for osteoporosis in young patients with ankylosing spondylitis, proactive management of the disease and regular monitoring can help mitigate this risk. It's essential to maintain a balanced diet, engage in regular physical activity, and adhere to your treatment regimen. If you have further concerns about your bone health or medication regimen, please consult your healthcare provider for tailored advice and management strategies.

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