A randomized controlled trial of calcium supplementation to increase bone mineral density in children with juvenile rheumatoid arthritis.
OBJECTIVE
To examine the effects of daily supplementation with calcium (Ca) in combination with vitamin D on total body and lumbar spine bone mineral density (BMD) in patients with juvenile rheumatoid arthritis (JRA) who had not taken corticosteroids for at least 3 months prior to the beginning of the study.


METHODS
One hundred ninety-eight children and adolescents (141 girls and 57 boys) with JRA, ages 6 to 18 years, with a mean +/- SD age of 11.7 +/- 3.3 years and a mean +/- SD disease duration of 5.6 +/- 3.8 years at the beginning of the study, were enrolled in this randomized double-blind, placebo-controlled trial to receive either daily oral supplements of 1,000 mg of Ca and 400 IU of vitamin D (n = 103) or matched placebo tablets and 400 IU of vitamin D (n = 95) for 24 months. Total body BMD (TBBMD) was measured by dual x-ray absorptiometry at baseline and every 6 months for 24 months.


RESULTS
At baseline, the mean +/- SD TBBMD was 0.89 +/- 0.14 gm/cm2 among patients randomized to the Ca group and 0.87 +/- 0.14 gm/cm2 among those randomized to placebo (P = 0.445). At 24 months, the mean +/- SD TBBMD among those receiving Ca was 0.95 +/- 0.13 gm/cm2, compared with 0.92 +/- 0.14 gm/cm2 among those receiving placebo. A longitudinal random-effects mixed model analysis that controlled for differences in the subject's initial BMD, sex, Tanner stage, adherence to the study medication regimen, and body composition revealed significantly higher TBBMD among patients who received Ca compared with patients who received placebo during the study period (P = 0.03).


CONCLUSIONS
Ca supplementation resulted in a small, but statistically significant, increase in TBBMD compared with placebo in children with JRA.
Lovell
Daniel J
DJ
Cincinnati Children's Hospital Medical Center, William S. Rowe Division of Rheumatology ML4010, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. daniel.lovell@cchmc.org
Glass
David
D
Ranz
Julie
J
Kramer
Sandy
S
Huang
Bin
B
Sierra
Rosa I
RI
Henderson
Carol J
CJ
Passo
Murray
M
Graham
Brent
B
Bowyer
Suzanne
S
Higgins
Gloria
G
Rennebohm
Robert
R
Schikler
Kenneth N
KN
Giannini
Edward
E
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D001823:Body Composition / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D001862:Bone Resorption / Q000188:drug therapy* / Q000209:etiology; D001842:Bone and Bones / Q000187:drug effects / Q000473:pathology; D002118:Calcium / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014807:Vitamin D / Q000494:pharmacology / Q000627:therapeutic use
D014807:Vitamin D; D002118:Calcium