title: Bone status evaluation with calcaneal ultrasound in children with chronic rheumatic diseases. A one year followup study.
abstract: OBJECTIVE
  To evaluate at baseline and after one year the bone status in children with chronic rheumatic diseases (CRD) using quantitative ultrasound techniques.
  
  
  METHODS
  We evaluated bone status in 67 children, 52 female, 15 male, age range 2.80 to 18.10 years; 46 juvenile idiopathic arthritis, 11 juvenile dermatomyositis, and 10 systemic lupus erythematosus. Twenty-seven of 67 patients were taking only nonsteroidal antiinflammatory drugs (NSAID), 11 were given NSAID and methotrexate (MTX), 15 were also receiving steroids (prednisone), and 14 patients were given steroids and alendronate. Broadband ultrasound attenuation (BUA) by bone was determined at the left calcaneus using two 12.5 mm diameter, 1 MHz transducers mounted in hand-held calipers linked to a pediatric contact ultrasound bone analyzer.
  
  
  RESULTS
  At baseline in the whole patient group mean BUA values and Z scores were significantly lower than in controls: 41.84 +/- 21.64 vs 61.69 +/- 17.42 dB/MHz (p < 0.001); Z score -0.91 +/- 1.07 vs 0.09 +/- 0.62 in controls (p < 0.001). At one year followup in the patient group BUA values were significantly increased compared to baseline (BUA 46.43 +/- 21.51 dB/MHz; p = 0.002); no significant difference was found in Z score. The 15 children receiving steroids in addition to NSAID and MTX showed a decrease in BUA value at one year (NS), while Z scores were significantly reduced compared to baseline (-1.45 +/- 1.40 vs -1.08 +/- 1.11; p < 0.05). The 14 patients in the group receiving NSAID and MTX who also received alendronate showed significant increases in BUA (56.93 +/- 19.32 vs 44.21 +/- 15.67; p < 0.001) and Z score (-0.87 +/- 1.19 vs -1.56 +/- 0.82; p < 0.002).
  
  
  CONCLUSIONS
  Contact ultrasound bone analysis at the calcaneus is a useful tool in the assessment and monitoring of bone status in children with CRD.
authors.affiliation: Department of Pediatrics, Rheumatology Unit, University of Florence, Italy. falcini@unifi.it
authors.forename: Fernanda
authors.initials: F
authors.lastname: Falcini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bindi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Simonini
authors.forename: Stefano
authors.initials: S
authors.lastname: Stagi
authors.forename: Fiorella
authors.initials: F
authors.lastname: Galluzzi
authors.forename: Laura
authors.initials: L
authors.lastname: Masi
authors.forename: Rolando
authors.initials: R
authors.lastname: Cimaz
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000188:drug therapy; D015519:Bone Density; D002111:Calcaneus / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003882:Dermatomyositis / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D012044:Regression Analysis; D012216:Rheumatic Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D011239:Prednisolone; D008727:Methotrexate