A two‐year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis

Lien, Gunhild; Selvaag, Anne M; Flatø, Berit; Haugen, Margaretha; Vinje, Odd; Sørskaar, Dag; Dale, Knut; Egeland, Thore; Førre, Ø

doi:10.1002/art.20963

Cited by 104 publications

(91 citation statements)

References 32 publications

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“…Data from most longitudinal studies are not directly comparable to ours because the commencement of their followup occurred on average 2 years following GC initiation (5,7,32). Within the entire cohort, 19% had L-spine aBMD Z scores of less than Ϫ2.0, which has been referred to as "low bone mass for chronologic age" in the literature (10,26).…”

Section: Discussionmentioning

confidence: 74%

Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

Rodd

Lang

Ramsay

et al. 2011

Arthritis Care & Research

127

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Objective. To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk.Methods. Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z scores, were analyzed for association with IVF. Results. Seven (6%) of 118 children (95% confidence interval 2.9 -11.7%) had IVF. Their diagnoses were: juvenile dermatomyositis (n ‫؍‬ 2), systemic lupus erythematosus (n ‫؍‬ 3), systemic vasculitis (n ‫؍‬ 1), and mixed connective tissue disease (n ‫؍‬ 1). One child was omitted from the analyses after 4 months because of osteoporosis treatment for symptomatic IVF. Children with IVF received on average 50% more GC than those without (P ‫؍‬ 0.030), had a greater increase in body mass index (BMI) at 6 months (P ‫؍‬ 0.010), and had greater decrements in spine aBMD Z scores in the first 6 months (P ‫؍‬ 0.048). Four (67%) of 6 children with IVF and data to 12 months had spine aBMD Z scores less than ؊2.0 at 12 months compared to 16% of children without IVF (P ‫؍‬ 0.011). Conclusion. The incidence of VF 12 months following GC initiation was 6%; most children were asymptomatic. Children with IVF received more GC, had greater increases in BMI, and had greater declines in spine aBMD Z scores in the first 6 months.

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Section: Discussionmentioning

confidence: 74%

Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

Rodd

Lang

Ramsay

et al. 2011

Arthritis Care & Research

127

View full text Add to dashboard Cite

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“…One child had mild disease primarily affecting the skin, which resulted in misdiagnosis for 99.7 months. Patients had a mean Ϯ SD DAS of 11.1 Ϯ 3.5 (median 11, range [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Clinical data for the children with juvenile DM, including anthropometric measurements, are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Not surprisingly, patients exposed to corticosteroids were observed to have lower bone density (3,4), although bone density also remained low in the absence of corticosteroid exposure (2,5). Recently, a prospective study evaluating children with JIA compared with healthy control subjects demonstrated that not only did children with JIA have decreased bone mineral content at baseline, but that over time the patients had a less-than-expected age-appropriate gain in bone mass (6).…”

mentioning

confidence: 99%

RANKL:Osteoprotegerin ratio and bone mineral density in children with untreated juvenile dermatomyositis

Rouster‐Stevens¹,

Langman²,

Price³

et al. 2007

Arthritis & Rheumatism

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Objective. To determine bone mineral density (BMD) in patients at the time of diagnosis of juvenile dermatomyositis (DM), to compare the RANKL: osteoprotegerin (OPG) ratio in patients with juvenile DM with that in healthy control subjects, and to evaluate whether BMD is associated with the RANKL:OPG ratio and the duration of untreated disease.Methods. Thirty-seven children with juvenile DM were enrolled. Dual x-ray absorptiometry (DXA) was performed before treatment, and Z scores for the lumbar spine (L1-L4) were determined. The duration of untreated disease was defined as the period of time from the onset of rash or weakness to the time at which DXA was performed. Serum specimens obtained at the time of DXA were analyzed for concentrations of RANKL and OPG, using enzyme-linked immunosorbent assay. The RANKL:OPG ratio was also determined in 44 age-matched healthy control subjects.Results. At the time of diagnosis of juvenile DM, patients had a significantly increased RANKL: OPG ratio compared with that in healthy children (mean ؎ SD 2.19 ؎ 3.03 and 0.13 ؎ 0.17, respectively; P < 0.0001). In patients with a lumbar spine BMD Z score of ؊1.5 or lower, the RANKL:OPG ratio was significantly higher than that in patients with a lumbar spine BMD Z score higher than ؊1.5 (P ‫؍‬ 0.038). Lumbar spine BMD Z scores (mean ؎ SD ؊0.13 ؎ 1.19 [range ؊2.10 to 2.85]) were inversely associated with the duration of untreated disease (R ‫؍‬ ؊0.50, P ‫؍‬ 0.003).Conclusion. Children with juvenile DM have an elevated RANKL:OPG ratio at the time of diagnosis, resulting in expansion of the number of osteoclasts and activation of the bone resorptive function. This may lead to a lack of normal bone mineral accretion and a subsequent reduction in the lumbar spine BMD Z score. Patients with a longer duration of untreated juvenile DM have reduced lumbar spine BMD Z scores. These data suggest that early diagnosis could reduce the likelihood of reduced lumbar spine BMD in these patients by prompting intervention strategies at an early stage.Children with rheumatic disease have decreased bone mineral density (BMD). Studies of BMD have primarily evaluated patients with juvenile idiopathic arthritis (JIA), and an inverse correlation between higher disease activity and lower BMD has been demonstrated in children with arthritis (1-4). Not surprisingly, patients exposed to corticosteroids were observed to have lower bone density (3,4), although bone density also remained low in the absence of corticosteroid exposure (2,5). Recently, a prospective study evaluating children with JIA compared with healthy control subjects demonstrated that not only did children with JIA have decreased bone mineral content at baseline, but that over time the patients had a less-than-expected age-appropriate gain in bone mass (6).Limited data exist concerning bone metabolism in children with juvenile dermatomyositis (DM), which is the most common pediatric inflammatory myopathy, with an annual incidence in the US of 3.2 cases per 1 Dr.

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“…Similarly, we did not evaluate the effect of activity on BMD, due to the retrospective study design. Although regular exercise is known to increase BMD in healthy children (51)(52)(53), studies in patients with pediatric rheumatic diseases have had conflicting results (16,28). Prospective studies are needed to determine the effects of calcium and vitamin D intake and exercise on BMD and fracture risk in juvenile SLE.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus

Compeyrot-Lacassagne¹,

Tyrrell²,

Atenafu³

et al. 2007

Arthritis & Rheumatism

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Objective. Studies of adults with systemic lupus erythematosus (SLE) have frequently demonstrated the presence of decreased bone mineral density (BMD).However, there have been few investigations in pediatric patients to date. This study was undertaken to determine the prevalence of low BMD in patients with juvenile SLE and to identify associated risk factors.Methods. We studied 64 consecutive patients with juvenile SLE in whom routine dual x-ray absorptiometry (DXA) scanning was performed. Lumbar spine osteopenia was defined as a BMD Z score of <؊1 and >؊2.5, and osteoporosis as a BMD Z score of <؊2.5. Decreased hip BMD was defined as a value of <80%. Data on disease activity, quality of life, disease-related damage, sex, ethnicity, body mass index, age at diagnosis, age at DXA, medication use and duration, clinical features, and puberty status were collected at the time of DXA.Results. Lumbar spine osteopenia was seen in 24 patients (37.5%) and osteoporosis in 13 (20.3%). Decreased hip BMD was present in 12 patients (18.8%). By univariate analysis, osteopenia was significantly correlated with age, disease duration, duration of corticosteroid use, cumulative corticosteroid dose, azathioprine use, cyclophosphamide use, lupus nephritis, and damage. Two additional variables, mycophenolate mofetil use and class III-IV nephritis, were associated with osteoporosis. Abnormal hip BMD was associated with disease duration, duration of corticosteroid use, and cumulative corticosteroid dose. By multivariate analysis, only disease duration remained in the model for osteoporosis and abnormal hip BMD, while cumulative corticosteroid dose was the variable associated with osteopenia.Conclusion. These results indicate that osteopenia and osteoporosis are common in juvenile SLE and are associated more closely with increased disease duration than with cumulative corticosteroid dose.

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A two‐year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis

Cited by 104 publications

References 32 publications

Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

RANKL:Osteoprotegerin ratio and bone mineral density in children with untreated juvenile dermatomyositis

Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus

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