Clinical Analysis And Risk Factors Of Osteoporosis In Children With Chronic Rheumatism And

1.Retrospective study of osteoporosis in children with chronic rheumatic diseasesObjective The rheumatic population is at particular risk for osteopenia or OP because of the chronic inflammatory nature of the underlying disease, GCs and delayed puberty, lack of physical activity. With improvements in treatment regimens, patients with CRD now can survive a much longer life, OP has became a complication that influence patients’ prognosis. The aim of this study is to summarize the clinical manifestations of OP, in order to improve the understanding of the diseases. Methods Patients with CRD and OP from the Department of pediatrics, Peking Union Medical College Hospital, were enrolled between Jan,2005 and May,2015. The general data, clinical features were analyzed retrospectively. All data were analysised using SPSS 20.0 software. Result 1. Thirteen OP patients were detected in 526(2.5%) CRD patients, of which 8 with SLE,3 with so-JIA,1 with MCTD, and 1 with JDM. Twelve of them were girls, one was boy. All the patients were treated with GCs.2. All patients had VF, none of them had long bone fractures.The VF were clustered in the lower thoracic spines and upper lumbar spines. Most of the VF were wedge. Patients had suffered from back pain, height loss, scoliosis.3.The duration of GCs treatment of 13 OP patients was 32.6±29.8 months (6-84 months), the average cumulative dosage of GCs was 22308.9±13520.8mg (6800-55365mg), and the average daily dosage was 33.9±15.8mg/d (9.95～65.9mg/d).4. The average BMD of lumbar spines of 11 patients tested by DXA was 0.69±0.10g/cm2 (0.566-0.855g/cm2), the average Z-score was -1.25±1.69 (-5.08～0.8), the average height adjusted Z-score was -0.52±1.01 (-2.75～0.49).5. The concentration of PTH was below the normal range in 6/12 patients, while the other 6/12 within the normal range. Two of nine patients were diagnosed vitamin D deficiency, while 7/9 patients were vitamin D insufficency, although all patient were supplemented with daily vitamin D. Seven of nine patients had elevated β-CTX.6. All of the patients were treated with vitamin D and calcium, and some were added with calcitonin or biphosphonates. Three cases were lost to follow up, other 10 had a medium treatment duration of 10 months (5-54months). Although treated as described above,2/10 still lost height; 1/8 got more decreased BMD result; 6/8 got more decreased Z-scores; 4/6 cases were labelled with vitamin D insufficiency; 2/6 cases were deficiency; while the concertation of β-CTX decreased in four of six patients.Conclusion The CRD patients could be complicated with OP, and vertebral fracture is the main clinical character-isitcs.The OP can occur before the loss of BMD to the extent of osteopnia.The CRD patients complicated with OP were labelled with vitamin D deficiency or insufficiency,the physician should increase the dose of vitamin D supplmentation in CRD patients.2.Risk factors of osteoporosis in juvenile onset systemic lupus erythematosusObjective To probe risk factors of OP in juvenile onset SLE. Methods Eight SLE patients complicated with OP diagnosed in the department of pediatrics, Peking union medical college hospital from Jan 2005 to May 2015, and 40 control SLE patients without OP matched with gender and age selected by case-control study method from 255 SLE patients who hospitalized in the same stage, were enrolled in the study. The ratio of case to control is 1:5. Clinical information and laboratory data of the 48 participents were collected and analyzed by SPSS 20.0 software. Independent samples T test was used to compare the different variables between the two groups. Then case-control Logistic regression analysis was practiced to explore the risk factors of OP in SLE. Results According to independent samples T test, compared to control cases, patients with OP had higher ALP (118.6±53.0U/L vs 77.1±37.7U/L, P=0.011), ALT (48.1±40.2U/L vs 23.8±10.8U/L, P=0.001), AST (65.5±104.1U/L vs 21.3±7.8U/L, P=0.008), and lower raw BMD(L1-L4) result (0.68±0.11g/cm2 vs 0.87±0.12g/cm2, P=0.002), age-and gender-matched BMD percentile (24.2%±31.4% vs 58.0%±30.3%, P=0.009), Z-Score (1.59±1.96 vs 0.32±1.06, P=0.042), height-adjusted Z-Score (-0.68±1.23 vs 0.90±0.91, P=0.013). According to case-control Logistic regression, lower height-adjusted Z-Score could be a risk factor of OP in SLE patients. Conclusion Patients with had lower BMD. Lower BMD could be associated with pathogenesis of OP in SLE patients. It is indicated that monitoring the BMD in SLE cases could be important to find early OP.