Cross-sectional and Longitudinal Evaluation of Bone Mass in Children and Young Adults with Juvenile Idiopathic Arthritis: The Role of Bone Mass Determinants in a Large Cohort of Patients

Stagi, Stefano; Masi, Laura; Serena, Capannini; Cimaz, Rolando; Tonini, Giulia; Matucci‐Cerinic, Marco; Martino, Maurizio de; Falcini, Fabio

doi:10.3899/jrheum.091241

Cited by 46 publications

(73 citation statements)

References 39 publications

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“…Cystic fibrosis, systemic lupus erythematosus, juvenile idiopathic arthritis, inflammatory bowel disease, celiac disease, chronic renal failure, childhood cancers, and cerebral palsy can all be associated with reduced bone mass. 78,[80][81][82][83][84] Risk factors include malnutrition, increased metabolic requirements, intestinal malabsorption, low body weight, chronic inflammation with increased cytokine production, hypogonadism, immobilization, and the effects of prolonged glucocorticoid therapy. Children with cerebral palsy are at particular risk.…”

Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

380

316

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The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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Section: Secondary Prevention: Assessment Of Populations At Risk For mentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

380

316

View full text Add to dashboard Cite

show abstract

“…Children and young adults with juvenile idiopathic arthritis showed a decreased BMD [1,7], particularly in polyarticular and systemic groups [7], with a reduced PBM and an increased risk of developing adult osteoporosis [1,2,7]. Disease severity, inflammatory mediators and GCs have a definitive pathogenetic role for low BMD and reduced PBM [1,7].…”

Section: "Secondary Osteoporosis Is Typically Multifactorial and It Omentioning

confidence: 99%

“…With regard to pediatric rheumatic diseases, much data incontrovertibly showed that juvenileonset systemic lupus erythematosus patients are more prone to suffer from decreased BMD [1,7,10], with a prevalence of osteopenia and PO of 37.5 and 20.3%, respectively [10]. Multiple causes, involving both disease-and nondisease-related factors, have been proposed as main reasons for bone loss, including reduced physical activity, limited exposure to sunlight, systemic inflammation, GCs, delay in pubertal development, inadequate dietary intake of calcium and vitamins, use of cytotoxic drugs and disease severity, especially nephritis.…”

Section: "Secondary Osteoporosis Is Typically Multifactorial and It Omentioning

confidence: 99%

“…Disease severity, inflammatory mediators and GCs have a definitive pathogenetic role for low BMD and reduced PBM [1,7].…”

Section: "Secondary Osteoporosis Is Typically Multifactorial and It Omentioning

confidence: 99%

“…An essential point for improving bone health is to reach a high peak bone mass (PBM). Even if the main factor for achieving a normal PBM in healthy individuals is genetically determined [6], PBM may be a major determinant of bone mass later in life [6,7], and it is critical to maximize the potential of reaching the most optimal value through management of potential factors contributing to KEYWORDS: bone mineral density n children n fragility fractures n osteopenia n osteoporosis n primary osteoporosis n secondary osteoporosis bone loss and osteoporosis. Environmental factors (e.g., sex hormones, calcium and vitamin D dietary intake, medication use and sedentary lifestyle) account for approximately 25% of the variance in PBM [6].…”

Section: Causes Of Pediatric Osteoporosismentioning

confidence: 99%

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Managing pediatric osteoporosis

Cimaz¹,

Stagi²

2013

International Journal of Clinical Rheumatology

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Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

Rodd

Lang

Ramsay

et al. 2011

Arthritis Care & Research

125

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Objective. To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk.Methods. Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z scores, were analyzed for association with IVF. Results. Seven (6%) of 118 children (95% confidence interval 2.9 -11.7%) had IVF. Their diagnoses were: juvenile dermatomyositis (n ‫؍‬ 2), systemic lupus erythematosus (n ‫؍‬ 3), systemic vasculitis (n ‫؍‬ 1), and mixed connective tissue disease (n ‫؍‬ 1). One child was omitted from the analyses after 4 months because of osteoporosis treatment for symptomatic IVF. Children with IVF received on average 50% more GC than those without (P ‫؍‬ 0.030), had a greater increase in body mass index (BMI) at 6 months (P ‫؍‬ 0.010), and had greater decrements in spine aBMD Z scores in the first 6 months (P ‫؍‬ 0.048). Four (67%) of 6 children with IVF and data to 12 months had spine aBMD Z scores less than ؊2.0 at 12 months compared to 16% of children without IVF (P ‫؍‬ 0.011). Conclusion. The incidence of VF 12 months following GC initiation was 6%; most children were asymptomatic. Children with IVF received more GC, had greater increases in BMI, and had greater declines in spine aBMD Z scores in the first 6 months.

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Cross-sectional and Longitudinal Evaluation of Bone Mass in Children and Young Adults with Juvenile Idiopathic Arthritis: The Role of Bone Mass Determinants in a Large Cohort of Patients

Cited by 46 publications

References 39 publications

Optimizing Bone Health in Children and Adolescents

Optimizing Bone Health in Children and Adolescents

Managing pediatric osteoporosis

Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

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