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Assessment of Osteoporosis by Quantitative Ultrasound versus Dual Energy X-Ray Absorptiometry in Children with Chronic Rheumatic Diseases
CORINA HARTMAN, RAANAN SHAMIR, ORLY ESHACH-ADIV, GALINA IOSILEVSKY, and RIVA BRIK
ABSTRACT. Methods. Forty children with CRD [32 with juvenile idiopathic arthritis (JIA), 6 with systemic lupus erythematosus, and 2 with dermatomyositis] aged 9.9 ± 4.3 years, were evaluated by QUBS of radius and tibia and DEXA of the lumbar spine. Twenty-five (62.5%) patients were treated with corticosteroids. Measurements of the velocity of the ultrasound wave, expressed as speed of sound (SOS) in m/s, and the results of the bone mineral density (BMD) assessed by DEXA were compared to reference data from healthy age and sex matched Israeli children. Results. Compared to controls, patients with CRD had significantly lower values by QUBS and DEXA alike. BMD and SOS z scores < –1 SD were found in 45% and 38% of the patients, respectively. Reduced BMD and SOS values correlated with age at disease onset and corticosteroid treatment. BMD alone correlated negatively with disease duration and methotrexate therapy. BMD was significantly lower in patients with polyarticular JIA compared to patients with oligoarticular disease (p < 0.03). SOS values did not differ between subtypes of JIA. A significant positive correlation was found between the lumbar DEXA and radius SOS. Conclusion. QUBS evaluation of radius and tibia yielded results comparable to DEXA and may therefore be used for screening patients with CRD for osteoporosis. QUBS might represent a promising means of evaluating bone quality in at-risk children. (J Rheumatol 2004;31:981-5) Key Indexing Terms:
OSTEOPOROSIS
From the Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Pediatric Rheumatology Clinic, and Department of Nuclear Medicine, Meyer Children's Hospital of Haifa, Rambam Medical Center, Bruce Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel. C. Hartman, MD, Senior Physician, Division of Pediatric Gastroenterology and Nutrition; R. Shamir, MD, Senior Lecturer, Head, Division of Pediatric Gastroenterology and Nutrition; O. Eshach-Adiv, MD, Senior Physician, Division of Pediatric Gastroenterology and Nutrition; G. Iosilevsky, MD, Department of Nuclear Medicine; R. Brik, MD, Associate Professor, Head, Department of Pediatrics and Pediatric Rheumatology Clinic, Meyer Children's Hospital of Haifa, Rambam Medical Center, Bruce Rappaport School of Medicine, Technion-Institute of Technology. Address reprint requests to Dr. R. Brik, Department of Pediatrics, Meyer Children's Hospital of Haifa, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel. Submitted April 19, 2002; revision accepted November 21, 2003. |