Abstract
Osteoporosis, a common clinical feature in children affected with Juvenile Rheumatoid Arthritis (JRA), is generally divided into two forms, a localized juxta-articular osteoporosis of the single joints and a generalized reduction of bone mass due to the disease itself, joint involvement and steroid treatment. Recently Dual Energy X-ray Absorptiometry (DEXA) has been suggested for Bone Mineral Density (BMD) measurement. In the present study DEXA has been used to investigate the lumbar spine BMD in JRA patients as compared to healthy children. Our results showed that BMD is reduced in JRA patients (BMD 0.685 g/cm2) when compared to healthy children (BMD 0.722 g/cm2), and it is significantly lower in the group of patients treated with steroids (BMD 0.623 g/cm2) when compared to those treated with nonsteroidal antiinflammatory drugs (BMD 0.710 g/cm2). The analysis of all risk factors of bone loss indicated that steroids represent the only parameter of significant negative correlation with BMD.
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Hillman L., Cassidy J.T., Johnson L., Lee D., Allen S.H. Vitamin D metabolism and bone mineralization in children with JRA. J. Pediatr. 124: 910, 1994.
Reed A.M., Haugen M., Pachman L.M., Langman C.B. Repair of osteopenia in children with juvenile rheumatoid arthritis. J. Pediatr. 122: 693, 1993.
Reed A.M., Haugen M., Pachman L.M., Langman C.B. Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases. J. Pediatr. 116: 574, 1990.
Hopp R., Degan J., Gallagher J.C., Cassidy J.T. Estimation of bone mineral density in children with Juvenile Rheumatoid Arthritis. J. Rheumatol 18: 1235, 1991.
Bianchi M.L., Bardare M., Cohen E., Cherubini R., Bigoni M. Bone density and body composition in juvenile rheumatoid arthritis. Proceeding of Fourth International Symposium on Osteoporosis and Consensus Development Conference. C. Christiansen Ed. Hong Kong. 203, 1993.
Varonos S., Ansell B.M., Reeve J. Vertebral collapse in juvenile chronic arthritis: its relationship with glucocorticoid therapy. Calcif. Tissue Int. 41: 75, 1987.
Reeve J., Loftus J., Hesp R., Ansell B.M., David D., Woo P.M. Deflazacort in Juvenile Chronic Arthritis. J. Rheumatol. 37: 1, 1993.
David J., Loftus J., Hesp R., Ansell B.M., Reeve J., Woo P.M. Spinal and somatic growth in patients with JCA treated for up 2 years with deflazacort. Clin. Exp. Rheum. 10: 621, 1992.
Sambrook P.N., Reeve J. Bone disease in rheumatoid arthritis. Clin. Sci. 74: 225, 1988.
Avioli L.V. Osteoporosis in rheumatoid arthritis. Arthr. Rheum. 30: 830, 1987.
Bijlsma J.W.J. Bone metabolism in patients with rheumatoid arthritis. Clin. Rheum. 7: 16, 1988.
Dykam T.R., Gluck O.S., Murphy M.A., Hahn T.J., Hahn B. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic disease. Arthr. Rheum. 28: 361, 1985.
Reeve J., Loftus J., Hesp R., Ansell B.M., Wright D.J., Woo P.M. Biochemical prediction of changes in spinal bone mass in juvenile chronic (or rheumatoid) arthritis treated with glucocorticoids. J. Rheumathol. 20: 1189, 1993.
Jergas M., Genant H.K. Current methods and recent advances in the diagnosis of osteoporosis. Arthr. Rheum. 36: 1649, 1993.
Ponder S.W., Mc Cormick D.P., Fawcett H.D., Palmer J.L., McKeman M.G., Brouhard B.H. Spine mineral bone density aged 5 through 11.99. AJDC 144: 1346, 1990.
DePriester J.A., Cole T.J., Bishop N.J. Bone growth and mineralization in children aged 4 to 10 years. Bone Miner. 12: 57, 1991.
Howe S., Levinson J., Shear E., Hartner S., McGirr G., Schulte M., Lovell D. Development of a disability measurement tool for Juvenile Rheumatoid Arthritis. Arthr. Rheum. 34: 873, 1991.
Gordon DA. Rheumatoid Arthritis-Contemporary patients management series, ed 2. Medical Examination Publishing, New York, 1985.
Fogelman I. Rheumatoid arthritis and osteoporosis. Br. J. Rheum. 25: 240, 1987.
Loftus J., Allen R., Hesp, David J., Reid D.M., Wright D.J., Green J.R., Reeve J., Ansell B.M., Woo P.M. Randomized double-blind trial of deflazacort versus prednisone in Juvenile Chronic (or Rheumatoid) Arthritis: a relatively bone-sparing effect of deflazacort. Pediatrics 88: 428, 1991.
Glastre C., Braillon P., David L., Cochat P., Meunier P.J., Delmas P.D. Measurement of bone mineral content of the lumbar spine by dual energy X-ray absorptiometry in normal children: correlations with growth parameters. J. Clin. Endocrinol. Metab. 70: 1330, 1990.
Wahner H.W., Dunn W.L., Brown M.L., Morin R.L., Riggs B.L. Comparison of dual energy X-ray absorptiometry and dual photon absorptiometry for bone mineral measurement of the lumbar spine. Mayo Clin. Proc. 63: 1075, 1988.
Gluer C.C., Steiger P., Selvidge R., Elliesen-Kuetoth K., Hayashi C., Genant H.K. Comparative assessment of dual-photon absorptiometry and dual energy radiography. Radiology 174: 223, 1990.
Southard R.N., Morris J.D., Mahan J.D., Hayes J.R., Torch M.A., Sommer A., Zipf W.B. Bone mass in healthy children: measurement with quantitative DXA. Radiology 179: 735, 1991.
Kroger H., Kotaniemi A., Vainio P., Alhava E. Bone densitometry of the spine and femur in children by dual energy x-ray absorptiometry. Bone Miner. 17: 75, 1992.
Dequeker J., Westhovens R. Low dose corticosteroid associated osteoporosis in Rheumatoid Arthritis and its prophylaxis and treatment: bone of contentions. J. Rheumatol. 22: 6, 1995.
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Falcini, F., Trapani, S., Civinini, R. et al. The primary role of steroids on the osteoporosis in juvenile rheumatoid arthritis patients evaluated by dual energy X-ray absorptiometry. J Endocrinol Invest 19, 165–169 (1996). https://doi.org/10.1007/BF03349860
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DOI: https://doi.org/10.1007/BF03349860