Increased Risk of Osteoporosis in Patients with Juvenile Arthritis!!!

Osteoporosis is characterized by abnormally low bone mass, micro-architectural deterioration of bone tissue leading to increased bone fragility, and a consequent increase in fracture risk. The term osteoporosis is widely used clinically to mean generalized loss of bone, or osteopenia, accompanied by relatively atraumatic fractures of the spine, wrist, hips, or ribs. It is manifested clinically as fractures, and, on noninvasive quantitative imaging tests, as low bone density. Osteoporotic fractures, particularly in aging women, represent a major health problem in industrialized nations. In the United States, approximately 150,000 hip fractures occur annually in women over age 65, with 15 percent to 25 percent of these women experiencing excess mortality or needing long-term nursing home care. While a certain amount of bone loss seems inevitable with the passage of time, the process is not entirely beyond our control. Dietary and lifestyle measures can, to some degree, help maintain bone health. Poor nutrition and other health habits such as smoking, alcohol abuse, and physical inactivity contribute to bone loss. Exercise, especially through activities like walking that put pressure on the weight-bearing bones, stimulates bone remodeling.

Juvenile idiopathic arthritis (JIA) is the most common form of persistent arthritis in children. (Juvenile in this context refers to an onset before age 16, idiopathic refers to a condition with no defined cause, and arthritis is the inflammation of a joint.) JIA occurs in both sexes, but, like other rheumatological diseases, is more common in females. The prognosis of JIA depends on prompt recognition and treatment.

A cross-sectional and longitudinal study assessed the prevalence of reduced bone mass in a large cohort of patients with juvenile idiopathic arthritis. The study included 219 patients with JIA with an average age of 8.7 years. Of those included in the study, 104 had oligoarticular JIA, 61 polyarticular, 20 systemic and 34 enteritis-related arthritis onset. Researchers evaluated the patients using a dual-energy x-ray absorptiometry (DEXA) scan of the lumbar spine. The data collected was then compared with 80 age- and sex-matched healthy controls. The results revealed that patients with JIA had low bone mass and after an initial increase due to therapy, still did not reach a healthy level despite newer and more effective drug treatments. Spine bone mineral density was correlated with sex, systemic corticosteroid exposure, number of intraarticular corticosteroid injections, interval from last steroid injection, erythrocyte sedimentation rate and C-reactive protein levels. Researchers suggested that since patients with JIA have a high risk of osteoporosis in early adulthood, their bone mass density should be closely monitored. It was also recommended that better control of disease activity, physical activity and intake of calcium and vitamin D may help prevent osteoporosis in patients with JIA.1

1 Staqi S, Masi L, Capannini S, et al. 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. J Rheumatol. Jun2010.