Abstract
The aim of this study is to evaluate body composition and the bone mineral density in female adolescents with juvenile systemic lupus erythematosus. Body composition (BC) and bone mineral density (BMD) were evaluated in an observational cohort study with 35 postmenarcheal adolescent females. The variables studied were as follows: current and cumulative corticosteroid dose, intake of supplements containing calcium and vitamin D, 24-h proteinuria, body mass index (BMI), and height for age (Z-score). BC was assessed using dual-energy X-ray absorptiometry (DXA) at two time points (median interval of 1.2 years). The fat mass index (FMI = fat mass in kilograms divided by the height in meters squared) and lean mass index (LMI = lean mass in kilograms divided by the height in meters squared) were calculated based on the DXA results. BMD was classified according to the International Society of Clinical Densitometry (low BMD for chronological age < −2.0 standard deviations). .The mean age of the subjects was 15.4 ± 1.8 years. Of patients, 54.3 % were normal weight, 22.8 % were overweight, 22.8 % were obese, and 8.6 % had short stature. Low BMD for chronological age was observed in 42.8 % of patients, and 60 % were not taking vitamin D. There was no significant difference between the two time points with respect to FMI, LMI, or body mass index Z-score (ZBMI); however, BMD has decreased significantly (p = 0.011). There was an association between not taking a vitamin D supplement and decreased BMD (p = 0.027). Almost half of the patients had altered nutritional status. The BMD decrease in adolescents with juvenile systemic lupus erythematosus (JSLE) was associated with the lack of vitamin D supplementation, highlighting the importance of well-defined vitamin D supplementation protocols.
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Rood MJ, ten Cate R, van Suijlekom-Smit LW et al (1999) Childhood-onset Systemic Lupus Erythematosus: clinical presentation and prognosis in 31 patients. Scand J Rheumatol 28:222–226
Hashkes PJ, Wright BM, Lauer MS et al (2010) Mortality outcomes in pediatric rheumatology in the US. Arthritis Rheum 62:599–608
Lilleby V (2007) Bone status in juvenile systemic lupus erythematosus. Lupus 16:580–586
Müller K, Kriegbaum NJ, Baslund B, Sørensen OH, Thymann M, Bentzen K (1995) Vitamin D3 metabolism in patients with rheumatic diseases: low serum levels of 25-hydroxyvitamin D3 in patients with systemic lupus erythematosus. Clin Rheumatol 14:397–400
Lahita RG, Bradlow HL, Ginzler E, Pang S, New M (1987) Low plasma androgens in women with systemic lupus erythematosus. Arthritis Rheum 30:241–248
Swaak AJ, van den Brink HG, Aarden LA (1996) Cytokine production (IL-6 and TNF alpha) in whole blood cell cultures of patients with systemic lupus erythematosus. Scand J Rheumatol 25:233–238
Tang XL, Qin L, Kwok AW et al (2013) Alterations of bone geometry, density, microarchitecture, and biomechanical properties in systemic lupus erythematosus on long-term glucocorticoid: a case-control study using HR-pQCT. Osteoporos Int 24:1817–1826
Tang XL, Griffith JF, Qin L, Hung VW, Kwok AW et al (2013) SLE disease per se contributes to deterioration in bone mineral density, microstructure and bone strength. Lupus 22.11:1162–1168
Borba VZ, Matos PG, da Silva Viana PR, Fernandes A, Sato EI, Lazaretti-Castro M (2005) High prevalence of vertebral deformity in premenopausal systemic lupus erythematosus patients. Lupus 14:529–533
Bultink IE, Lems WF, Kostense PJ, Dijkmans BA, Voskuyl AE (2005) Prevalence of and risk factors for low bone mineral density and vertebral fractures in patients with systemic lupus erythematosus. Arthritis Rheum 52:2044–2050
Helba M, Binkovitz LA (2009) Pediatric body composition analysis with dual-energy X-ray absorptiometry. Pediatr Radiol 39:647–656
Castro TC, Terreri MT, Szejnfeld VL et al (2002) Bone mineral density in juvenile systemic lupus erythematosus. Braz J Med Biol Res 35:1159–1163
Alsufyani KA, Ortiz-Alvarez O, Cabral DA et al (2005) Bone mineral density in children and adolescents with systemic lupus erythematosus, juvenile dermatomyositis, and systemic vasculitis: relationship to disease duration, cumulative corticosteroid dose, calcium intake, and exercise. J Rheumatol 32:729–733
Lilleby V, Lien G, Frey Frøslie K, Haugen M, Flatø B, Førre Ø (2005) Frequency of osteopenia in children and young adults with childhood-onset systemic lupus erythematosus. Arthritis Rheum 52:2051–2059
Compeyrot-Lacassagne S, Tyrrell PN, Atenafu E et al (2007) Prevalence and etiology of low bone mineral density in juvenile systemic lupus erythematosus. Arthritis Rheum 56:1966–1973
Regio P, Bonfá E, Takayama L, Pereira R (2008) The influence of lean mass in trabecular and cortical bone in juvenile onset systemic lupus erythematosus. Lupus 17:787–792
Casella CB, Seguro LP, Takayama L, Medeiros D, Bonfa E, Pereira RM (2012) Juvenile onset systemic lupus erythematosus: a possible role for vitamin D in disease status and bone health. Lupus 21:1335–1342
Trapani S, Civinini R, Ermini M, Paci E, Falcini F (1998) Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density. Rheumatol Int 18:45–49
Lim LS, Benseler SM, Tyrrell PN et al (2012) Predicting longitudinal trajectory of bone mineral density in paediatric systemic lupus erythematosus patients. Ann Rheum Dis 71:1686–1691
Abdwani R, Abdulla E, Yaroubi S, Bererhi H, Al-Zakwani I (2015) Bone mineral density in juvenile onset systemic lupus erythematosus. Indian Pediatr 52:38–40
Mok CC (2013) Vitamin D, and systemic lupus erythematosus: an update. Expert Rev Clin Immunol 9:453–463
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
de Onis M, Garza C, Victora CG (2003) The WHO Multicentre Growth Reference Study: strategy for developing a new international growth reference. Forum Nutr 56:238–240
Khan AA, Bachrach L, Brown JP et al (2004) Standards and guidelines for performing central dual-energy x-ray absorptiometry in premenopausal women, men, and children. J Clin Densitom 7:51–64
Lilleby V, Haugen M, Mørkrid L, Frey Frøslie K, Holven KB, Førre O (2007) Body composition, lipid and lipoprotein levels in childhood-onset systemic lupus erythematosus. Scand J Rheumatol 36:40–47
Tekano JL, Tucker L, Khattra P (2006) Limiting obesity in children with rheumatic diseases requiring corticosteroid therapy [abstract]. Arthritis Rheum 54:S529
Abou-Raya A, Abou-Raya S, Helmii M (2013) The effect of vitamin D supplementation on inflammatory and hemostatic markers and disease activity in patients with systemic lupus erythematosus: a randomized placebo-controlled trial. J Rheumatol 40:265–272
Bonakdar ZS, Jahanshahifar L, Jahanshahifar F, Gholamrezaei A (2011) Vitamin D deficiency and its association with disease activity in new cases of systemic lupus erythematosus. Lupus 20:1155–1160
Hamza RT, Awwad KS, Ali MK, Hamed AI (2011) Reduced serum concentrations of 25-hydroxy vitamin D in Egyptian patients with systemic lupus erythematosus: relation to disease activity. Med Sci Monit 17:CR711–CR718
Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS (2006) Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev 5:114–117
Sumethkul K, Boonyaratavej S, Kitumnuaypong T et al (2013) The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus. Rheumatol Int 33:1461–1467
Toloza SM, Cole DE, Gladman DD, Ibañez D, Urowitz MB (2010) Vitamin D insufficiency in a large female SLE cohort. Lupus 19:13–19
Souto M, Coelho A, Guo C et al (2011) Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity. Lupus 20:1019–1026
Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Arthritis Rheum 2001; 44:1496–503
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Caetano, M., Terreri, M.T., Ortiz, T. et al. Bone mineral density reduction in adolescents with systemic erythematosus lupus: association with lack of vitamin D supplementation. Clin Rheumatol 34, 2065–2070 (2015). https://doi.org/10.1007/s10067-015-3011-1
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DOI: https://doi.org/10.1007/s10067-015-3011-1