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Objective  This study aimed to assess the relationship between bone marrow edema (BME) on magnetic resonance imaging (MRI) and bone mineral density (BMD) in patients with ankylosing spondylitis (AS).    Methods  The study included 333 patients with AS who underwent BMD measurements and axial MRI. Additionally, 106 normal controls were included. The modified New York criteria were used as the classification criteria of AS. Clinical, laboratory, and imaging data were collected and analyzed. Lumbar spine and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Low BMD was defined by a Z-score ≤-2. The Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index was used to assess inflammation at the sacroiliac joint (SIJ) and spine.    Results  Among the 333 patients, the male:female ratio was 4.6:1, mean patient age was 28.5±10.6 years, and mean disease duration was 7.3±6.8 years. The prevalences of low BMD, osteopenia, and osteoporosis were significantly higher among AS patients than among controls (19.8%, 62.8%, and 5.7% vs. 4.7%, 33.0%, and 0%, respectively,  P  = 0.000). The BMD values were significantly lower and prevalences of low BMD at both the spine and femur were significantly higher among patients with BME on MRI than among those without BME. Multivariate logistic regression analysis showed that male sex (OR 3.87, 95% CI 1.21–7.36,  P  = 0.023), high ASDAS-CRP score (OR 2.83, 95% CI 1.36–4.76,  P  = 0.015), the presence of BME on sacroiliac MRI (OR 2.83, 95% CI 1.77–6.23,  P  = 0.000) and spinal MRI (OR 4.06, 95% CI 1.96–8.46,  P  = 0.000), and high grade of sacroiliitis (OR 2.93, 95% CI 1.82–4.45,  P  = 0.002) were risk factors for low BMD (any site). The SPARCC scores of the SIJ were negatively correlated with femoral BMD (r = -0.22, 95% CI -0.33 to -0.10,  P  = 0.000). Additionally, the SPARCC scores of the spine were negatively correlated with BMD values (r = -0.23, 95% CI -0.36 to -0.09,  P  = 0.003) and Z-scores (r = -0.24, 95% CI -0.36 to -0.12,  P  = 0.001) at the spine.    Conclusion  Low BMD is common in AS patients. BME on MRI is highly associated with low BMD at both the spine and femur.

Bone edema on magnetic resonance imaging is highly associated with low bone mineral density in patients with ankylosing spondylitis