Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis

JinShik Shin; Min Jae Kang; Kwang Nam Kim

doi:10.4078/jrd.2018.25.4.248

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Shin, Kang, and Kim: Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis

Original Article

J Rheum Dis 2018;25(4):248-254.

Published online: 31 October 2018

DOI: https://doi.org/10.4078/jrd.2018.25.4.248

Prevalence of Lower Bone Mineral Density and Its Associated Factors in Korean Children and Adolescents with Juvenile Idiopathic Arthritis

JinShik Shin, Min Jae Kang, Kwang Nam Kim

Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea

Corresponding to: Kwang Nam Kim http://orcid.org/0000-0003-4024-5128 Department of Pediatrics, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea. E-mail: kwangnamkim@naver.com

Received 24 April 201826 June 2018 Accepted 28 June 2018

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study examined the prevalence of low-bone mineral density (BMD) and its associated factors in Korean children and adolescents with juvenile idiopathic arthritis (JIA).

Methods

Thirty-nine patients with JIA were included in this cross-sectional study. The patients were examined for their bone age (BA) and bone mineral density (BMD). The BMD was measured using dual-energy X-ray absorptiometry on the lumbar spine. Each BMD value was converted to a Z-score by comparing the reference values of the healthy control group in terms of the age and sex of each patient, which was measured using the same device. A Z-score of less than −2.0 was defined as a low BMD. Laboratory tests were performed to detect the serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D levels.

Results

The mean age at the time of the examination was 12.2±3.6 years, and the study comprised a total of 39 patients (16 males, 23 females). Patients with systemic JIA had a lower BMD, which was calculated based on the CA, BA, and HA, than those with non-systemic JIA (P=0.020, P=0.049, and P=0.024, respectively); the corticosteroid user group also showed a lower BMD, which had been calculated based on the CA, BA, and HA, than the corticosteroid non-user group (p=0.002, p=0.022, and p=0.188, respectively).

Conclusion

This study suggests that JIA patients have a lower BMD than control subjects. Therefore, treatment, and education are warranted while treating patients with JIA, particularly those requiring oral corticosteroids or those with systemic JIA and appropriate laboratory tests.

Keywords: Juvenile idiopathic arthritis, Bone mineral density

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Figure 1.

Comparison of BMD between JIA and control group. CA: chronological age, BA: bone age, HA: height age, BMD: bone mineral density, JIA: juvenile idiopathic arthritis. *p-value＜0.05.

Table 1.

Clinical characteristics of patients with juvenile idiopathic arthritis

Characteristics	Total (n=39)
Age at examination (yr)	12.2±3.6
Age at diagnosis (yr)	6.7±3.6
Disease duration (yr)	5.2±4.0
Height SDS	−0.7±1.7
Weight SDS	−0.3±1.4
BMI SDS	−0.1±1.2
Calcium (mg/dl)	9.4±0.3
Phosphorus (mg/dl)	4.6±0.5
Alkaline phosphatase (U/L)	234.9±109.8
25-OH vitamin D (ng/ml)	17.9±8.9
Use of oral corticosteroids (ever, yes or no)	27 (69.2)
Duration of oral corticosteroids (yr)	1.8±2.4
Cumulative dose of corticosteroid (mg)	7,722.2±8,876.1

Data are expressed as mean±standard deviation or number (%). SDS: standard deviation score, BMI: body mass index.

Table 2.

BMD of patients accordin g to levels of 25-OH vitamin D

Level of 25-OH vitamin D		Deficient (＜20 ng/ml), n=25 (64%)	Normal (≥20 ng/ml), n=14 (36%)	p-value
BMD Z-score	CA	−0.94±1.53	−0.64±1.82	0.26
	BA	−1.18±1.94	−0.66±1.48	0.37
	HA	−0.38±1.20	−0.36±1.26	0.91

Data are expressed as mean±standard deviation. BMD: bone mineral density, CA: chronological age, BA: bone age, HA: height age.

Table 3.

Comparison of BMD between systemic JIA and non-systemic JIA patients

		Systemic JIA, n=16 (41%)	Non-systemic JIA, n=23 (59%)	p-value
BMD Z-score	CA	−1.42±1.27	−0.42±1.74	0.020
	BA	−1.72±2.21	−0.48±1.24	0.049
	HA	−0.76±1.02	−0.11±1.27	0.024

Data are expressed as mean±standard deviation. BMD: bone mineral density, JIA: juvenile idiopathic arthritis, CA: chronological age, BA: bone age, HA: height age.

Table 4.

Comparison of BMD between corticosteroid users and corticosteroid non-users

		Corticosteroid users, n=27 (69%)	Corticosteroid non-users, n=12 (31%)	p-value
BMD Z-score	CA	−1.39±1.35	0.28±1.59	0.002
	BA	−1.50±1.76	0.02±1.40	0.022
	HA	−0.54±1.22	–0.06±1.14	0.188

Data are expressed as mean±standard deviation. BMD: bone mineral density, CA: chronological age, BA: bone age, HA: height age.

Table 5.

Regression analysis of clinical variables and BMD

Variable	BMD Z-score
	CA base				BA base				HA base
	CI at 95%		β	p-value	CI at 95%		β	p-value	CI at 95%		β	p-value
	Lower limit	Upper limit	β	p-value	Lower limit	Upper limit	β	p-value	Lower limit	Upper limit	β	p-value
Weight SDS	0.507	1.055	0.781	0.001	0.332	1.030	0.681	0.048	0.214	0.689	0.451	0.303
Height SDS	0.334	0.835	0.585	0.008	0.252	0.848	0.550	0.021	0.526	0.739	0.632	＜0.001
Disease duration	−0.135	0.132	−0.002	0.202	−0.124	0.169	0.023	0.151	−0.224	−0.048	−0.136	0.014

BMD: bone mineral density, CA: chronological age, BA: bone age, HA: height age, CI: confidential interval, SDS: standard deviation score.

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