title: Prevalence of vertebral compression fractures and associated factors in children and adolescents with severe juvenile idiopathic arthritis.
abstract: OBJECTIVE
  Vertebral fractures occur in patients with juvenile idiopathic arthritis (JIA), but data on their frequency and causes are scarce. Our cross-sectional study evaluated prevalence of compression fractures and associated factors in a high-risk pediatric population with severe JIA.
  
  
  METHODS
  Children and adolescents with a history of treatment-resistant polyarticular-course JIA for ≥ 5 years or systemic arthritis for ≥ 3 years were recruited. Clinical examination, dietary recall, laboratory measurements, bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry, and spinal radiography were performed.
  
  
  RESULTS
  Our study included 50 patients (41 girls), of whom 6 (12%) had systemic arthritis, with a median age of 14.8 years (range 7.0-18.7 yrs) and median disease duration of 10.2 years (range 3.9-16.8 years). Ninety-four percent had used systemic glucocorticoids (GC); the median total duration of GC treatment was 7.1 years (range 0-15.5 yrs). The median weight-adjusted cumulative GC dose for the preceding 3 years was 72 mg/kg (range 0-911 mg/kg). The median bone age-corrected lumbar spine and whole-body areal BMD Z-scores were -0.8 and -1.0, respectively. Twenty-two percent had vertebral fractures, mostly thoracic. Compression fractures were associated with high disease activity, high body mass index (BMI), and high recent cumulative GC dose, but not with disease duration or BMD. Thirty percent had sustained at least 1 peripheral low energy fracture. Twenty-six percent were deemed to have significantly compromised bone health.
  
  
  CONCLUSIONS
  Severe JIA is associated with a significant risk of vertebral compression fractures. Associated factors include high disease activity, high BMI, and high recent GC exposure. Further studies are needed to establish optimal prevention and treatment guidelines.
authors: Paediatric Research Center, Tampere University Hospital, Tampere, Finland. kati.markula-patjas@pshp.fi
authors: Kati P
authors: KP
authors: Markula-Patjas
authors: Helena L
authors: HL
authors: Valta
authors: Liisa I
authors: LI
authors: Kerttula
authors: Irma H
authors: IH
authors: Soini
authors: Visa E A
authors: VE
authors: Honkanen
authors: Sanna-Maria
authors: SM
authors: Toiviainen-Salo
authors: Outi M
authors: OM
authors: Mäkitie
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000365:Age Determination by Skeleton; D001171:Arthritis, Juvenile / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D015992:Body Mass Index; D015519:Bone Density; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015995:Prevalence; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000293:injuries
chemical_list: D005938:Glucocorticoids