Low bone mass in juvenile onset sclerosis systemic: the possible role for 25-hydroxyvitamin D insufficiency

Abstract

Juvenile onset systemic sclerosis (JoSSc) is a rare disease, and there are no studies focusing in bone mineral density and biochemical bone parameters. Ten consecutive patients with JoSSc and 10 controls gender, age, menarche age, and physical activity matched were selected. Clinical data were obtained at the medical visit and chart review. Laboratorial analysis included autoantibodies, 25-hydroxyvitamin D (25OHD), intact parathyroid hormone, calcium, phosphorus, alkaline phosphatase and albumin sera levels. Bone mineral density was analyzed by dual-energy X-ray absorptiometry, and bone mineral apparent density (BMAD) was calculated. A lower BMAD in femoral neck (0.294 ± 0.060 vs. 0.395 ± 0.048 g/cm(3), P = 0.001) and total femur (0.134 ± 0.021 vs. 0.171 ± 0.022 g/cm(3), P = 0.002) was observed in JoSSc compared to controls. Likewise, a trend to lower BMAD in lumbar spine (0.117 ± 0.013 vs. 0.119 ± 0.012 g/cm(3), P = 0.06) was also found in these patients. Serum levels of 25OHD were significantly lower in JoSSc compared to controls (18.1 ± 6.4 vs. 25.1 ± 6.6 ng/mL, P = 0.04), and all patients had vitamin D insufficiency (<20 ng/mL) compared to 40% of controls (P = 0.01). All other biochemical parameters were within normal range and alike in both groups. BMAD in femoral neck and total femur was correlated with 25OHD levels in JoSSc (r = 0.82, P = 0.004; r = 0.707, P = 0.02; respectively). We have identified a remarkable high prevalence of 25OHD insufficiency in JoSSc. Its correlation with hip BMAD suggests a causal effect and reinforces the need to incorporate this hormone evaluation in this disease management.

Does Vitamin D Affect Risk of Developing Autoimmune Disease?: A Systematic Review

“…Of the five case-control studies, two demonstrated lower 25(OH) D levels in patients with scleroderma than controls(142, 143), and three did not(144-146). In two case-only analyses, it was found that 25(OH)D levels were, not surprisingly, lower in those with more severe underlying scleroderma, more longstanding disease, more disease activity, more pulmonary hypertension and lower diffusing lung capacity(147, 148).…”

Role of Vitamin D in Systemic Sclerosis: A Systematic Literature Review

“…Many recent articles have tried to clarify the association of low vitamin D levels with bone mineral density (BMD) in SSc and fracture risk in SSc patients, based on the role of vitamin D in calcium-phosphate and bone homeostasis. Overall, decreased bone mineral density (BMD) was reported in the majority of scleroderma patients presenting with low levels of vitamin D (<30 ng/ml) [ 36 – 39 ]. In addition, Shinjo et al identified a high prevalence of 25(OH)D insufficiency in SSc that correlates with hip BMD (femoral neck and total femur) [ 39 ].…”

Dualities of the vitamin D in systemic sclerosis: a systematic literature review

“…Several experts agree to define vitamin D deficiency as serum levels below 10 ng/ml [9,10,16,18,22,38]. However, this definition is not universal, with some authors suggesting deficiency levels to be lower than 20 ng/ml (50 nmol/l) [39,41], taking in consideration the regulatory variations of PTH. In turn, vitamin D insufficiency is commonly defined as serum levels between 10 and 30 ng/ml, with levels > 30 ng/ml being considered sufficient [9,22,24,27].…”