Bone Problems in Rheumatic Diseases During Childhood and Adolescence

ISSN： 1534-8644

Source： Clinical Review in Bone and Mineral Metabolism, Vol.2, Iss.1, 2004-03, pp. : 63-76

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Abstract

Metabolic disorders of bone in children and adolescents affected by many chronic rheumatic diseases (most commonly juvenile rheumatoid arthritis, systemic lupus erythematosus, and dermatomyositis) are an important complication as well as a side effect of therapy. In the absence of prevention measures, fragility fractures can occur even at an early age.Glucocorticosteroids, probably the most important drugs in chronic inflammatory diseases with an autoimmune component, have now been proven to constantly induce osteoporosis and increase the rate of fragility fractures even in young patients. Also, they can prevent the acquisition of an optimal peak bone mass and lead to an increased risk of fractures in later life.The daily "stress stimuli," such as walking, running, stair climbing, etc., are critical for skeletal development during childhood and adolescence. Mobility can be significantly reduced in many rheumatologic diseases and disuse osteopenia is frequent.Effective control of the rheumatologic disease is the best first-line approach to preventing osteoporosis. Growth and pubertal delay must be corrected with an appropriate hormonal therapy. Assuring an adequate intake of calcium, phosphate, and protein, as well as maximizing mobility, are especially important in young patients.Very few studies are available on the treatment of low bone mass and bone metabolism derangement in children with rheumatic diseases, treated with glucocorticosteroids or not. Controlled studies are still lacking. Calcium, vitamin D, and 25-hydroxyvitamin D have been studied in pediatric patients with various rheumatic diseases, but their efficacy in reducing or preventing bone loss is uncertain. There are some preliminary data on the efficacy of bisphosphonates in severe osteoporosis or high-risk conditions. Growth hormone has also been used.