title: The impact of underlying disease on fracture risk and bone mineral density in children with rheumatic disorders: A review of current literature.
abstract: Childhood rheumatic diseases are associated with negative impacts on the skeleton, related to both the underlying illness and complications of therapy. The effects of medications like corticosteroids are well recognized, leading to reductions in bone mineral density and bone strength and concomitant increases in bone fragility and fracture risk. The impact of factors directly attributable to the underlying disease is not as well recognized. In this article, we review relevant literature to identify data which can contribute to an understanding of the impact of childhood rheumatic disease on the skeleton. We conclude that childhood rheumatic diseases are associated with reductions in bone mineral density and increased risk of vertebral and non-vertebral fractures. These data are strongest for juvenile arthritis, while conclusions are more limited for other rheumatic illnesses, like juvenile systemic lupus erythematosus or juvenile dermatomyositis, due to small numbers of patients studied. Finally, we make recommendations for areas in need of further research. These include the need for long-term longitudinal studies and for data to be collected in patients who have not been treated with corticosteroids.
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, 5850 University Ave, Halifax, Nova Scotia, Canada B3K 6R8. Electronic address: adam.huber@iwk.nshealth.ca.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber
authors.affiliation: Division of Pediatric Endocrinology, Children׳s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Ward
mesh_terms: D015519:Bone Density / Q000187:drug effects* / Q000502:physiology; D002648:Child; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*
chemical_list: D005938:Glucocorticoids
keywords: Bone fragility; Bone mineral density; Juvenile arthritis; Juvenile dermatomyositis; Juvenile idiopathic arthritis; Juvenile rheumatic disease; Juvenile systemic lupus erythematosus; Non-vertebral fractures; Vertebral fractures