A systematic review of the effectiveness of strategies for reducing fracture risk in children with juvenile idiopathic arthritis with additional data on long-term risk of fracture and cost of disease management

Abstract

BMD, adjusted for size, should be assessed as the primary outcome in studies of bone health in children with JIA. Quantitative computed tomography could be used where equipment is available as it offers the advantage of measuring volumetric density. Bisphosphonates are a promising treatment for osteoporosis in children with JIA, but the quality of the current evidence is poor. The accurate assessment of outcome is crucial. There are still uncertainties about the use of bisphosphonates in children, including whether the positive effects of treatment continue over time, the length of treatment and the maximal bone mass gain that can be achieved. Adults with JIA may have persistent low BMD compared with an otherwise healthy population together with an increased risk of fracture. There are no studies evaluating the costs of treating children with JIA and low BMD and/or fragility fractures. There are few data evaluating the costs of treating JIA in general. In the first 12 months after diagnosis, children with all JIA disease subtypes consume large, but highly variable, quantities of health service resources, the largest component being the consultant rheumatology appointments. Data from a larger cohort, over a longer period, are required to substantiate these results further. Further research is needed to assess more clearly the role and permit licensing of bisphosphonates for treatment of children, and in particular, longer-term studies.

Proteomic Analysis of Plasma to Reveal the Impact of Short-Term Etanercept Therapy in Pediatric Patients with Enthesitis-Related Arthritis: A Case Report

“…The main function of VDBP is to bind and transport vitamin D, which plays a major role in calcium homeostasis and bone turnover. A previous study postulated that children with some types of JIA may be at risk for bone fractures [74,75] and that VDBP was significantly overexpressed in polyarticular JIA patients [45]. Certain pro-inflammatory cytokines such as IL-1, TNF-, and IL-6 are increased in ERA subjects and are involved in the pathogenesis of various bone disorders [9,76].…”

Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia

“…Some have suggested that interval monitoring of BMD may be more predictive of fracture risk, but acknowledge that this is unproven and could be misleading [30]. Other studies suggest that the use of the Z-score is more appropriate for younger patients, however, they are again limited in their evidence of fracture risk [31]. In addition, as T-scores are compared with a standard of healthy young individuals (age 20-29), Z-scores for young patients are, in general, identical to their T-scores, and thus provide little additional data.…”

Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats

“…In addition, according to the American College of Rheumatology, it is also indicated for the primary prevention of glucocorticoid-induced osteoporosis (6). In this context, attempts to extend the list of diseases, which would benefit from primary prevention with bisphosphonate treatment must be counterbalanced by considering an array of peculiarities and potentially negative issues: a) the mechanism behind bone loss, i.e., decreased bone formation or increased bone resorption, b) concerns exist about how long bone remodeling could artificially be inhibited by anti-resorptive drugs without serious impairment of bone repairing capacity (7), and c) the effectiveness of pharmacologic therapy in the prevention of osteoporosis in young individuals (8). …”