Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

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/cm3, P = 0.001) and total femur (0.134 ± 0.021 vs. 0.171 ± 0.022 g/cm3, 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/cm3, 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Foeldvari I (2008) Update on pediatric systemic sclerosis: similarities and differences from adult disease. Curr Opin Rheumatol 20:608–612

    Article  PubMed  Google Scholar 

  2. Souza RB, Borges CT, Takayama L, Aldrighi JM, Pereira RM (2006) Systemic sclerosis and bone loss: the role of the disease and body composition. Scand J Rheumatol 35:384–387

    Article  PubMed  CAS  Google Scholar 

  3. Carbone L, Tylavsky F, Wan J, McKown K, Cheng S (1999) Bone mineral density in scleroderma. Rheumatology (Oxford) 37:1–2

    Google Scholar 

  4. Di Munno O, Mazantini M, Massel P, Ferdeghini M, Petaro N, Latorraca A, Ferri C (1995) Reduced bone mass and normal calcium metabolism in systemic sclerosis with and without calcinosis. Clin Rheumatol 14:407–412

    Article  PubMed  CAS  Google Scholar 

  5. La Montagna G, Vatti M, Valenti G, Tirri G (1991) Osteopenia in systemic sclerosis evidence of a participating role of earlier menopause. Clin Rheumatol 10:18–22

    Article  PubMed  Google Scholar 

  6. Szodoray P, Nakken B, Gaal J, Jonsson R, Szegedi A, Zold E, Bodolay E (2008) The complex role of vitamin D in autoimmune diseases. Scand J Immunol 68:261–269

    Article  PubMed  CAS  Google Scholar 

  7. Mouyis M, Ostor AJK, Crisp AJ, Ginawi A, Halsall DJ, Shenker N, Poole KE (2008) Hypovitaminosis D among rheumatologic outpatients in clinical practice. Rheumatology 47:1348–1351

    Article  PubMed  CAS  Google Scholar 

  8. Kamen D, Aranow C (2008) Vitamin D in systemic lupus erythematosus. Curr Opin Rheumatol 20:532–537

    Article  PubMed  CAS  Google Scholar 

  9. Costenbader KH, Feskanich D, Holmes M, Karlson EW, Benito-Garcia E (2008) Vitamin D intake and risks of systemic lupus erythematosus and rheumatoid arthritis in women. Ann Rheum Dis 67:530–535

    Article  PubMed  CAS  Google Scholar 

  10. Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412

    Article  PubMed  CAS  Google Scholar 

  11. Cutolo M, Otsa K (2008) Review: vitamin D, immunity and lupus. Lupus 17:6–10

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG, Iowa Women’s Health Study (2004) Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 50:72–77

    Article  PubMed  CAS  Google Scholar 

  14. Cutolo M, Otsa K, Uprus M, Paolino S, Seriolo B (2007) Vitamin D in rheumatoid arthritis. Autoimmun Rev 7:59–64

    Article  PubMed  CAS  Google Scholar 

  15. Braun-Moscovici Y, Furst DE, Markovits D, Rozin A, Clements PJ, Nahir AM, Balbir-Gurman A (2008) Vitamin D, parathyroid hormone, and acroosteolysis in systemic sclerosis. J Rheumatol 35:2201–2205

    Article  PubMed  CAS  Google Scholar 

  16. LeRoy EC, Medsger TA (2001) Criteria for the classification of early systemic sclerosis. J Rheumatol 28:1573–1575

    PubMed  CAS  Google Scholar 

  17. Len C, Goldenberg J, Ferraz MB, Hilário MO, Oliveira LM, Sacchetti S (1994) Crosscultural reliability of the Childhood Health Assessment Questionnaire. J Rheumatol 21:2349–2352

    PubMed  CAS  Google Scholar 

  18. Prochaska JJ, Sallis JF, Long B (2001) A physical activity screening measure for use with adolescents in primary care. Arch Pediatr Adolesc Med 155:554–559

    PubMed  CAS  Google Scholar 

  19. Council for Physical Education for Children (1998) Physical activity for children: a statement of guidelines. National Association for Sport and Physical Education, Reston, VA

    Google Scholar 

  20. Santiago RA, Silva CA, Caparbo VF, Sallum AM, Pereira RM (2008) Bone mineral apparent density in juvenile dermatomyositis: the role of lean body mass and glucocorticoid use. Scand J Rheumatol 37:40–47

    Article  PubMed  CAS  Google Scholar 

  21. El-Hajj Fuleihan G, Nabulsi M, Choucair M, Salamoun M, Hajj Shahine C, Kizirian A, Tannous R (2001) Hypovitaminosis D in healthy schoolchildren. Pediatrics 107:E53

    Article  PubMed  CAS  Google Scholar 

  22. Khan AA, Bachrach L, Brown JP, Hanley DA, Josse RG, Kendler DL, Leib ES, Lentle BC, Leslie WD, Lewiecki EM, Miller PD, Nicholson RL, O’Brien C, Olszynski WP, Theriault MY, Watts NB (2004) Standards and guidelines for performing central dual-energy X-ray absorptiometry in premenopausal women, men, and children. J Clin Densitom 7:51–64

    Article  PubMed  Google Scholar 

  23. Cooper C, Harvey N, Javaid K, Hanson M, Dennison E (2008) Growth and bone development. Nestle Nutr Workshop Ser Pediatr Program 61:53–68

    Article  PubMed  Google Scholar 

  24. Cooper C, Westlake S, Harvey N, Javaid K, Dennison E, Hanson M (2006) Review: developmental origins of osteoporotic fracture. Osteoporos Int 17:337–347

    Article  PubMed  Google Scholar 

  25. Seeman E (2002) Pathogenesis of bone fragility in women and men. Lancet 25(359):1841–1850

    Article  Google Scholar 

  26. Kamel HK (2006) Postmenopausal osteoporosis: etiology, current diagnostic strategies, and nonprescription interventions. J Manag Care Pharm 12(6 Suppl A):S4–S9

    PubMed  Google Scholar 

  27. Popat VB, Prodanov T, Calis KA, Nelson LM (2008) The menstrual cycle: a biological marker of general health in adolescents. Ann N Y Acad Sci 1135:43–51

    Article  PubMed  Google Scholar 

  28. Bailey DA, McKay HA, Mirwald RL, Crocker PR, Faulkner RA (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: the university of Saskatchewan bone mineral accrual study. J Bone Miner Res 14:1672–1679

    Article  PubMed  CAS  Google Scholar 

  29. Baxter-Jones AD, Kontulainen SA, Faulkner RA, Bailey DA (2008) A longitudinal study of the relationship of physical activity to bone mineral accrual from adolescence to young adulthood. Bone 43:1101–1107

    Article  PubMed  Google Scholar 

  30. Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–145

    Article  PubMed  CAS  Google Scholar 

  31. Eriksson S, Mellström D, Strandvik B (2009) Volumetric bone mineral density is an important tool when interpreting bone mineralization in healthy children. Acta Paediatr 98:374–379

    Article  PubMed  Google Scholar 

  32. Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LM, Vieira JG, Kunii I, Hayashi LF, Corrêa MP, Lazaretti-Castro M (2005) Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of São Paulo (23 degrees 34′S), Brazil. Osteoporos Int 16:1649–1654

    Article  PubMed  CAS  Google Scholar 

  33. Johnson SR, Glaman DD, Schentag CT, Lee P (2006) Quality of life and functional status in systemic sclerosis compared to other rheumatic diseases. J Rheumatol 33:1117–1122

    PubMed  Google Scholar 

  34. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28 (Erratum in: Am J Clin Nutr 84:1253)

    PubMed  CAS  Google Scholar 

  35. Timpson NJ, Sayers A, Davey-Smith G, Tobias JH (2009) How does body fat influence bone mass in childhood? A Mendelian randomization approach. J Bone Miner Res 24:522–533

    Article  PubMed  Google Scholar 

  36. Hämäläinen H, Kautiainen H, Kaarela K, Kotaniemi A (2005) The development of bone mineral density and the occurrence of osteoporosis from 15 to 20 years of disease onset in patients with rheumatoid arthritis. Clin Exp Rheumatol 23:193–198

    PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants of Conselho Nacional de Desenvolvimento Científico e Tecnológico [300559/2009-7 to R.M.R.P., 305468/2006-5 to E.B.] and Federico Foundation to E.B.

Conflict of interest statement

All authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Disciplina de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, 30 andar, sala 3105, São Paulo, SP, 01246-903, Brazil

    Samuel Katsuyuki Shinjo, Eloisa Bonfá, Valéria de Falco Caparbo & Rosa Maria Rodrigues Pereira

Authors
  1. Samuel Katsuyuki Shinjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eloisa Bonfá
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valéria de Falco Caparbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosa Maria Rodrigues Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosa Maria Rodrigues Pereira.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shinjo, S.K., Bonfá, E., de Falco Caparbo, V. et al. Low bone mass in juvenile onset sclerosis systemic: the possible role for 25-hydroxyvitamin D insufficiency. Rheumatol Int 31, 1075–1080 (2011). https://doi.org/10.1007/s00296-010-1421-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-010-1421-6

Keywords

Search

Navigation