title: Bone mineral apparent density in juvenile dermatomyositis: the role of lean body mass and glucocorticoid use.
abstract: OBJECTIVE
  To analyse bone mineral density (BMD) in juvenile dermatomyositis (JDM) and its possible association with body composition, disease activity, duration of disease, glucocorticoid (GC) use, and biochemical bone parameters, including osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB (RANKL).
  
  
  METHODS
  Twenty girls with JDM and 20 controls matched for gender and age were selected. Body composition and BMD were analysed by dual-energy X-ray absorptiometry (DXA) and bone mineral apparent density (BMAD) was calculated. Duration of disease, cumulative GC, and GC pulse therapy use were determined from medical records. Disease activity and muscle strength were measured by the Disease Activity Score (DAS), the Childhood Myositis Assessment Scale (CMAS), and the Manual Muscle Test (MMT). Inflammatory and bone metabolism parameters were also analysed. OPG and RANKL were measured in patients and controls using an enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  A lower BMAD in the femoral neck (p<0.001), total femur (p<0.001), and whole body (p = 0.005) was observed in JDM patients compared to controls. Body composition analysis showed a lower lean mass in JDM compared to controls (p = 0.015), but no difference was observed with regard to fat mass. A trend of lower serum calcium was observed in JDM (p = 0.05), whereas all other parameters analysed, including OPG and RANKL, were similar. Multiple linear regression analysis revealed that, in JDM, lean mass (p<0.01) and GC pulse therapy use (p<0.05) were independent factors for BMAD in the hip region.
  
  
  CONCLUSIONS
  This study has identified low lean mass and GC pulse therapy use as the major factors for low hip BMAD in JDM patients.
authors.affiliation: Department of Paediatrics, University of Sao Paulo, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Santiago
authors.forename: C A A
authors.initials: CA
authors.lastname: Silva
authors.forename: V F
authors.initials: VF
authors.lastname: Caparbo
authors.forename: A M E
authors.initials: AM
authors.lastname: Sallum
authors.forename: R M R
authors.initials: RM
authors.lastname: Pereira
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D001827:Body Height / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D015519:Bone Density / Q000187:drug effects; D002118:Calcium / Q000097:blood; D002648:Child; D003882:Dermatomyositis / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D014807:Vitamin D / Q000097:blood
chemical_list: D005938:Glucocorticoids; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium