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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
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
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
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