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Bone Health and Growth in Glucocorticoid-Treated Patients with Juvenile Idiopathic Arthritis
HELENA VALTA, PEKKA LAHDENNE, HANNU JALANKO, KRISTIINA AALTO, and OUTI MÄKITIE ABSTRACT. Objective. To evaluate bone health and growth and their correlates in glucocorticoid (GC)-treated pediatric patients with juvenile idiopathic arthritis (JIA). Methods. Consecutive patients with a history of JIA for ≥ 2 years and systemic GC treatment for ≥ 3 months were assessed for bone health and its determinants. Areal bone mineral density (aBMD) and vertebral body morphology were assessed with DEXA; Z scores were adjusted for calendar and bone age. Values were correlated with biochemistry, disease activity, and medications. Results. Sixty-two patients (43 female; median age 11.8 yrs, median disease duration 5.6 yrs) were included. The median duration of GC treatment was 24 months and the median cumulative dose (as prednisolone) was 2.2 g. Four patients had had fractures. The median bone age-corrected aBMD Z score was –0.4 (range –2.9 to +1.8) for lumbar spine and –0.1 (range –2.1 to +2.4) for femoral neck. Abnormal vertebral morphology was observed in 6 patients (10%). No correlation was found between aBMD and disease characteristics or cumulative GC dose. The median Z score for height was +0.1 (range –2.9 to +1.5) and the median height-adjusted weight +4% (range –17% to +40%). Conclusion. Our study showed low prevalence of osteoporosis and normal growth in children with JIA. However, asymptomatic vertebral fractures were observed in 10% of the patients, indicating that DEXA alone may not be sufficient when evaluating bone health in these children. Osteoporosis still remains a concern in children with GC-treated JIA. (First Release Feb 15 2007; J Rheumatol 2007;34:831–6) Key Indexing Terms:
JUVENILE IDIOPATHIC ARTHRITIS From the Hospital for Children and Adolescents, Metabolic Bone Clinic and Pediatric Rheumatology Clinic, University of Helsinki, Helsinki, Finland. Supported by the Päivikki and Sakari Sohlberg Foundation, the Foundation for Pediatric Research, the Sigrid Juselius Foundation, the Finnish Medical Society Duodecim, and the Helsinki University Hospital research funds, Helsinki, Finland. H. Valta, MD; H. Jalanko, MD, PhD; O. Mäkitie, MD, PhD, The Hospital for Children and Adolescents, Metabolic Bone Clinic; P. Lahdenne, MD, PhD; K. Aalto, MD, PhD, The Hospital for Children and Adolescents, Pediatric Rheumatology Clinic. Address reprint requests to Dr. H. Valta, The Hospital for Children and Adolescents, Metabolic Bone Clinic, Helsinki University Hospital, PO Box 281, FIN-00029 Helsinki, Finland. E-mail: helena.valta@hus.fi Accepted for publication December 27, 2006.
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