A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis.
OBJECTIVE
To examine a behavioral intervention (BI) to increase calcium intake in children with juvenile rheumatoid arthritis (JRA) on calcium intake and bone mass 6 and 12 months after treatment.


METHODS
A randomized trial compared a 6-session BI to a 3-session enhanced standard of care (ESC) with 49 children ages 4 to 10 years with JRA. Calcium intake was assessed via 3-day diet diaries. Total body bone mineral content (BMC), arms and legs BMC, and lumbar spine bone mineral density were assessed by dual energy x-ray absorptiometry.


RESULTS
BI maintained an average calcium intake of 1500 mg/d at 6- and 12-month follow-up. This was greater than their baseline level of 972 mg/d, but not greater than the intake of 1300 mg/day maintained by ESC (P=.09). The BI had a 4% and 2.9% greater gain in total body bone mineral content than ESC at 6 and 12 months, respectively (P=.005), and a 7.1% and 5.3% greater gain in arms and legs BMC at 6 and 12 months than ESC (P=.0007).


CONCLUSIONS
BI is effective in increasing calcium intake and BMC in children with JRA over a 12-month period.
Stark
Lori J
LJ
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, OH 45229, USA. Lori.Stark@chmcc.org
Davis
Ann McGrath
AM
Janicke
David M
DM
Mackner
Laura M
LM
Hommel
Kevin A
KA
Bean
Judy A
JA
Lovell
Daniel
D
Heubi
James E
JE
Kalkwarf
Heidi J
HJ
D000328:Adult; D001171:Arthritis, Juvenile / Q000150:complications / Q000178:diet therapy*; D001521:Behavior Therapy; D015519:Bone Density; D002112:Calcifediol / Q000097:blood; D002136:Calcium, Dietary / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000517:prevention & control*; D016487:Parenting; D010349:Patient Compliance; D011615:Psychotherapy, Group
D002136:Calcium, Dietary; D002112:Calcifediol