Bone mineral density, T- and Z-scores in young men with juvenile idiopathic arthritis
Keywords:juvenile idiopathic arthritis, bone mineral density, young males, osteoporosis, osteopenia, T-score, Z-score
Background. Juvenile Idiopathic Arthritis (JIA) is a term used to classify a group of heterogeneous pediatric rheumatic diseases. Many of these conditions persist through adulthood. Presence of chronic inflammatory disease along with a glucocorticoid treatment is the risk factor of osteoporosis in young adult males. The purpose was to study the bone mineral density (BMD), T- and Z-scores in young adult males with JIA. Materials and methods. The study included 50 patients aged 19–25 years, divided into two groups: I — 25 apparently healthy young males; ІІ — 25 young men from different regions of Ukraine with a history of JIA in childhood, regardless of the presence or absence of active inflammation at the time of the observation. Two-energy X-ray densitometry (Prodigy, GE Lunar, Madison, USA) was performed at the D.F. Chebotarev Institute of Gerontology, Ukrainian Scientific-Medical Centre for the Problems of Osteoporosis, together with analysis of BMD, T- and Z-scores at different skeletal areas. Results. Young men with JIA and healthy individuals did not differ in age, height, weight and body mass index. Four patients with JIA (16 %) had fractures, while in the control group, there were no fractures. Negative impact of the JIA on the BMD was found in group II compared to group I. Lumbar spine BMD in group II was lower (p < 0.01) than in healthy subjects, as well as the Z-score (p < 0.001) in the L1-L4 lumbar spine region. BMD, T- and Z-scores in femoral neck region were lower in group II than in group I (p < 0.001; p < 0.001; p < 0.01, respectively). Significant differences between the two groups were found in total body BMD (p < 0.001), T-score (p < 0.01), Z-score (p < 0.05). Patients with JIA had lower BMD (p < 0.01) and T-score (p < 0.05) of the ultradistal radius. Decrease of BMD up to the level of osteopenia (Z-score < –2 SD) was found in 20 % patients at the level of L1-L4 lumbar spine, in 8 % — at femoral neck, in 12 % — at total body and in 8 % patients at the level of ultradistal radius. Conclusions. Young men with JIA aged 19–25 years had reduced total body BMD, T- and Z-scores, which indicate the negative impact of the disease on the bone tissue compared with healthy men of the corresponding age.
Bertilsson L, Anderson-Gare B, Fasth A, Petersson IF, Forsblad-D’elia H. Disease course, outcome and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol. 2013;40(5):715-724. doi.org/10.3899/jrheum.1206022.
Povoroznyuk VV, Dzhus MB. Bone mineral density in young females with juvenile idiopathic arthritis. Bol', Sustavy, Pozvonochnik. 2017;7(2):49-54. doi: 10.22141/2224-1507.7.2.2017.108696. (in Ukrainian).
Povoroznyuk VV, Amosova KM, Dzhus MB. Age pecularities of bone mineral density in young women with juvenile idiopathic arthritis. Ukr Rheum J. 2017;(69):22-26.
Bonjour JP, Chevalley T, Rizzoli R, Ferrari S. Gene–environment interactions in the skeletal response to nutrition and exercise during growth. Med Sport Sci. 2007;51:64-80. doi: 10.1159/000103005.
Clark EM, Ness AR, Bishop NJ, Tobias JH. Association between bone mass and fractures in children: a prospective cohort study. J Bone Miner Res. 2006;9(21):1489-1495. doi.org/10.1359/jbmr.0601.
Ferrari S, Bianchi ML, Eisman JA, et al. Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int. 2012;23(12):2735-2748. doi 10.1007/s00198-012-2030-x.
Bailey DA, Wedge JH, McCulloch RG, Martin AD, Bernhardson SC. Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am. 1989;8(71-A):1225-1231. doi: 10.2106/00004623-198971080-00016.
Haugen M, Lien G, Flatøetal B. Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm. Arthritis Rheum. 2000 Jul;43(7):1504-10. doi: 10.1002/1529-0131(200007)43:7<1504::AID-ANR13>3.0.CO;2-0.
Lien G, Flatø B, Haugen M, et al. Frequency of osteopenia in adolescents with early-onset juvenile idiopathic arthritis: a long-term outcome study of one hundred five patients. Arthritis Rheum. 2003;48(8):2214-2223. doi: 10.1002/art.11097.
Pepmueller PH, Cassidy JT, Allen SH, Hillman LS. Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum. 1996;39(5):746-757. doi: 10.1002/art.1780390506.
Seeman E, Bianchi G, Khosla S, Kanis JA, Orwoll E. Bone fragility in men—where are we? Osteoporos Int. 2006;17(11):1577-1583. doi: 10.1007/s00198-006-0160-8.
Ferrari SL, Chevalley T, Bonjour JP, Rizzoli R. Childhood fractures are associated with decreased bone mass gain during puberty: an early marker of persistent bone fragility? J Bone Miner Res. 2006;21(4):501-507. doi: 10.1359/jbmr.051215.
Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. 2017 Nov;104:29-38. doi: 10.1016/j.bone.2017.01.024.
Adler RA. Osteoporosis in men: insights for the clinician. Ther Adv Musculoskelet Dis. 2011;3(4):191-200. doi: 10.1177/1759720X11411600.
Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22. doi: 10.1210/jc.2011-3045.
Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton 2001. J Rheumatol. 2004;31:390-2. PMID: 14760812.
Riis BJ. Biochemical markers of bone turnover. II: Diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993 Nov 30;95(5A):17S-21S. doi:10.1016/0002-9343(93)90376-Z.
Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: Synopsis of a WHO report. Osteoporos Int. 1994 Nov;4(6):368-81. PMID: 7696835.
Bianchi M. Osteoporosis in children and adolescents. Bone. 2007;4(41):486-495. doi: 10.1016/j.bone.2007.07.008.
Baim S, Binkley N, Bilezikian JP, et al. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom. 2008;11:75-91. doi: 10.1016/j.jocd.2007.12.007.
Vasdev V, Bhakuni D, Garg MK, Narayanan K, Jain R, Chadha D. Bone mineral density in young males with ankylosing spondylitis. Int J Rheum Dis. 2011;14(1):68-73. doi: 10.1111/j.1756-185X.2010.01577.x.
Povoroznyuk VV, Orlik TV, Kreslov EO. Contemporary approach to the problem of osteoporosis in men in Ukraine. Bol', Sustavy, Pozvonochnik. 2012;2(06):42-49. (in Ukrainian).
Specker BL, Wey HE, Smith EP. Rates of bone loss in young adult males. Int J Clin Rheumtol. 2010;5(2):215-228. doi: 10.2217/ijr.10.7.
Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int. 1998;8(5):468-490. PMID: 9850356.
Marwaha RK, Tandon N, Shivapasad C, et al. Peak bone mineral density of physically active healthy Indian men with adequate nutrition and no known current constraints to bone mineralization. J Clin Densitom. 2009;12(3):314-321. doi: 10.1016/j.jocd.2009.05.004.
Henry MJ, Pasco JA, Korn S, et al. Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int. 2010;21(6):909-17. doi: 10.1007/s00198–009–1042–1047.
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