title: Protecting Bone Health in Pediatric Rheumatic Diseases: Pharmacological Considerations.
abstract: Bone health in children with rheumatic conditions may be compromised due to several factors related to the inflammatory disease state, delayed puberty, altered life style, including decreased physical activities, sun avoidance, suboptimal calcium and vitamin D intake, and medical treatments, mainly glucocorticoids and possibly some disease-modifying anti-rheumatic drugs. Low bone density or even fragility fractures could be asymptomatic; therefore, children with diseases of high inflammatory load, such as systemic onset juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, and those requiring chronic glucocorticoids may benefit from routine screening of bone health. Most commonly used assessment tools are laboratory testing including serum 25-OH-vitamin D measurement and bone mineral density measurement by a variety of methods, dual-energy X-ray absorptiometry as the most widely used. Early disease control, use of steroid-sparing medications such as disease-modifying anti-rheumatic drugs and biologics, supplemental vitamin D and calcium, and promotion of weight-bearing physical activities can help optimize bone health. Additional treatment options for osteoporosis such as bisphosphonates are still controversial in children with chronic rheumatic diseases, especially those with decreased bone density without fragility fractures. This article reviews common risk factors leading to compromised bone health in children with chronic rheumatic diseases and discusses the general approach to prevention and treatment of bone fragility.
authors.affiliation: Pediatric Rheumatology Division, Floating Hospital for Children at Tufts Medical Center, 800 Washington Street, #190, Boston, MA, 02111, USA.
authors.forename: Yujuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Pediatric Rheumatology Division, Floating Hospital for Children at Tufts Medical Center, 800 Washington Street, #190, Boston, MA, 02111, USA. DMilojevic@tuftsmedicalcenter.org.
authors.forename: Diana
authors.identifier: http://orcid.org/0000-0003-2252-7076
authors.initials: D
authors.lastname: Milojevic
mesh_terms: D015502:Absorptiometry, Photon; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000503:physiopathology; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001842:Bone and Bones / Q000378:metabolism* / Q000503:physiopathology; D002648:Child; D003882:Dermatomyositis / Q000188:drug therapy / Q000503:physiopathology; D004164:Diphosphonates / Q000627:therapeutic use; D015444:Exercise; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000503:physiopathology; D010024:Osteoporosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012216:Rheumatic Diseases / Q000188:drug therapy / Q000503:physiopathology*; D012307:Risk Factors
chemical_list: D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids