Bone health and growth in glucocorticoid-treated patients with juvenile idiopathic arthritis.
OBJECTIVE
To evaluate bone health and growth and their correlates in glucocorticoid (GC)-treated pediatric patients with juvenile idiopathic arthritis (JIA).


METHODS
Consecutive patients with a history of JIA for >or= 2 years and systemic GC treatment for >or= 3 months were assessed for bone health and its determinants. Areal bone mineral density (aBMD) and vertebral body morphology were assessed with DEXA; Z scores were adjusted for calendar and bone age. Values were correlated with biochemistry, disease activity, and medications.


RESULTS
Sixty-two patients (43 female; median age 11.8 yrs, median disease duration 5.6 yrs) were included. The median duration of GC treatment was 24 months and the median cumulative dose (as prednisolone) was 2.2 g. Four patients had had fractures. The median bone age-corrected aBMD Z score was -0.4 (range -2.9 to +1.8) for lumbar spine and -0.1 (range -2.1 to +2.4) for femoral neck. Abnormal vertebral morphology was observed in 6 patients (10%). No correlation was found between aBMD and disease characteristics or cumulative GC dose. The median Z score for height was +0.1 (range -2.9 to +1.5) and the median height-adjusted weight +4% (range -17% to +40%).


CONCLUSIONS
Our study showed low prevalence of osteoporosis and normal growth in children with JIA. However, asymptomatic vertebral fractures were observed in 10% of the patients, indicating that DEXA alone may not be sufficient when evaluating bone health in these children. Osteoporosis still remains a concern in children with GC-treated JIA.
Valta
Helena
H
Hospital for Children and Adolescents, Metabolic Bone Clinic, University of Helsinki, Helsinki, Finland. helena.valta@hus.fi
Lahdenne
Pekka
P
Jalanko
Hannu
H
Aalto
Kristiina
K
Mäkitie
Outi
O
D000293:Adolescent; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000473:pathology*; D015519:Bone Density / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects* / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography
D018501:Antirheumatic Agents; D005938:Glucocorticoids