Bone mineral density of Brazilian girls with juvenile dermatomyositis

Abstract

We measured bone mineral density (BMD) in girls with juvenile dermatomyositis (JDM) considering multiple factors in order to determine if it could be used as a predictor of reduction in bone mass. A cross-sectional study of lumbar spine BMD (L2-L4) was conducted on 10 girls aged 7-16 years with JDM. A group of 20 age-matched healthy girls was used as control. Lumbar spine BMD was measured by dualenergy X-ray absorptiometry. Weight, height and pubertal Tanner stage were determined in all patients and controls. Duration of disease and mean daily and cumulative steroid doses were calculated for all patients on the basis of their medical charts. JDM activity was determined on the basis of the presence of muscle weakness, cutaneous vasculitis and/or elevation of serum concentration of one or more skeletal muscle enzymes. Seven patients demonstrated osteopenia or osteoporosis. Lumbar BMD was significantly lower in the JDM patients than the age-matched healthy control girls (0.712 vs 0.878, respectively; Student t-test, P = 0.041). No significant correlation between BMD and age, height, Tanner stage, disease duration, corticosteroid use, or disease activity was observed in JDM girls, but a correlation was observed between BMD and weight (Pearson's correlation coefficient, r = 0.802). Patients with JDM may be at risk for a significant reduction in BMD that might contribute to further skeletal fragility. Our results suggest that reduced bone mass in JDM may be related to other intrinsic mechanisms in addition to steroid treatment and some aspects of the disease itself may contribute to this condition.

High frequency of osteoporosis and fractures in women with dermatomyositis/polymyositis

“…In agreement with these findings, other studies on juvenile DM/PM have also failed to demonstrate an association between low bone mass and disease activity [4,13], and also glucocorticoid use [13]. One possible explanation for this result may be due to the limited number of patients, since myositis is a rare disease.…”

“…Regarding bone mineral density and fractures, we and other authors have analyzed these issues solely in children and adolescents with idiopathic inflammatory myositis [4,[11][12][13]. Most of them found low bone mineral density in these patients, even when the disease was inactive, with or without the use of glucocorticoids [4,[11][12][13].…”

“…Most of them found low bone mineral density in these patients, even when the disease was inactive, with or without the use of glucocorticoids [4,[11][12][13].…”

Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders

“…Reductions in lumbar spine (L-spine), femoral neck, and distal radial bone mineral density (BMD) in children with juvenile idiopathic arthritis (JIA) have been consistently documented among those who have been treated with glucocorticoids (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) and those who have not (1-6,8,9,12,14 -16). Reduced Lspine BMD has also been shown in children with juvenile dermatomyositis (DM) (17)(18)(19)(20)(21) and in juvenile systemic lupus erythematosus (SLE) (3,(21)(22)(23)(24)(25)(26)(27).…”

Avaliação de parâmetros do metabolismo ósseo e da saúde oral em pacientes com lúpus eritematoso sistêmico juvenil

“…Pacientes com doenças crônicas autoimunes frequentemente apresentam redução da massa óssea e, consequentemente, maior risco de fraturas 1,[12][13][14][15][16][17] . Vários fatores estão implicados no desenvolvimento da osteoporose nas doenças imuno-inflamatórias, entre eles: tempo, atividade e gravidade da doença; imobilização prolongada; desnutrição; inatividade física e uso de medicamentos, particularmente os GC 14,17 .…”