Bone Health and Growth in Glucocorticoid-Treated Patients with Juvenile Idiopathic Arthritis

OBJECTIVE: To evaluate bone health and growth and their correlates in glucocorticoid (GC)-treated pediatric patients with juvenile idiopathic arthritis (JIA). METHODS: Consecutive patients with a history of JIA for ≥ 2 years and systemic GC treatment for ≥ 3 months were assessed for bone health and its determinants. Areal bone mineral density (aBMD) and vertebral body morphology were assessed with DEXA; Z scores were adjusted for calendar and bone age. Values were correlated with biochemistry, disease activity, and medications. RESULTS: Sixty-two patients (43 female; median age 11.8 yrs, median disease duration 5.6 yrs) were included. The median duration of GC treatment was 24 months and the median cumulative dose (as prednisolone) was 2.2 g. Four patients had had fractures. The median bone age-corrected aBMD Z score was -0.4 (range -2.9 to +1.8) for lumbar spine and -0.1 (range -2.1 to +2.4) for femoral neck. Abnormal vertebral morphology was observed in 6 patients (10%). No correlation was found between aBMD and disease characteristics or cumulative GC dose. The median Z score for height was +0.1 (range -2.9 to +1.5) and the median height-adjusted weight +4% (range -17% to +40%). CONCLUSION: Our study showed low prevalence of osteoporosis and normal growth in children with JIA. However, asymptomatic vertebral fractures were observed in 10% of the patients, indicating that DEXA alone may not be sufficient when evaluating bone health in these children. Osteoporosis still remains a concern in children with GC-treated JIA.