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Osteoporosis in Children With Systemic Lupus Erythematosus Linked to Disease Duration



Osteopaenia and osteoporosis are common in children with systemic lupus erythematosus (SLE) and is linked more closely with disease duration than with the cumulative corticosteroid dose, report researchers in the journal Arthritis & Rheumatism.

Studies of adults with SLE have shown an increased risk of decreased bone mineral density (BMD), but this relationship has not been studied in paediatric patients, write researchers Sandrine Compeyrot-Lacassagne, Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada, and colleagues.

The researchers therefore conducted a study to look at the prevalence of low bone mineral density (BMD) and to identify associated risk factors in 64 consecutive patients with juvenile SLE at their institution for whom routine dual x-ray absorptiometry (DXA) scans were available.

Data were collected for all patients at DXA scan regarding disease activity, quality of life, disease-related damage, sex, ethnicity, body mass index, age at diagnosis, age at DXA, medication use and duration, clinical features, and puberty status.

They defined osteopaenia at the lumbar spine as a BMD Z score between -2.5 and -1, and osteoporosis as a BMD Z score of < -2.5. Decreased BMD at the hip was defined as < 80%.

Results showed that 37.5% of patients had lumbar spine osteopaenia and 20.3% had osteoporosis at the lumbar spine, while 18.8% had decreased BMD at the hip.

Univariate analysis showed that osteopaenia and osteoporosis each correlated significantly with age, disease duration, duration of corticosteroid use, cumulative corticosteroid dose, use of azathioprine or cyclophosphamide, lupus nephritis, and joint damage. Osteoporosis was also associated with mycophenolate mofetil use and class 3-4 nephritis.

The researchers also found a correlation between abnormal BMD at the hip and disease duration, duration of corticosteroid use, and cumulative corticosteroid dose.

Multivariate analysis showed that only disease duration remained as a risk factor for osteoporosis and abnormal hip BMD, while cumulative corticosteroid dose remained as a risk factor for osteopenia.

The findings of this study show that osteopaenia and osteoporosis are common in children with SLE and are associated more closely with increased disease duration than with cumulative corticosteroid dose.

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