eISSN: 1896-9151
ISSN: 1734-1922
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vol. 5

Clinical research
Evaluation of bone mineral density and bone turnover markers in Egyptian children with juvenile rheumatoid arthritis

Manal E. Kandil
Abbass Mourad
Azza El Hamshary
Gehan Hussein
Azza Ahmed
Sohair Abdel Mawgoud

Arch Med Sci 2009; 5, 3: 434-442
Online publish date: 2009/10/22
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Introduction: To evaluate bone mineral density (BMD) and levels of bone turnover markers in Egyptian children with juvenile rheumatoid arthritis (JRA), and its relationship with disease-related variables.
Material and methods: A case-control study included thirty children having JRA and 25 healthy controls. They were subjected to measurement of BMD of lumbar spines (L2-L4) and femoral neck using dual-energy-X-ray absorptiometry (DXA) with laboratory evaluation of bone turnover markers including serum receptor activator of nuclear factor kB-ligand (RANKL) and osteoprotegerin (OPG).
Results: Patients had significantly lower femoral neck BMD than controls (p = 0.02), and it was significantly lower in patients with corticosteroid therapy (p = 0.04). Eight patients (26.7%) and only 2 (8%) controls had low BMD at lumbar spine, while 13 patients (43.3%) and 2 (8%) controls had low BMD at femoral neck. Patients showed significantly higher RANKL, OPG and deoxypyridinolin (p = 0.0001, p = 0.049, p = 0.047), while calcium, osteocalcin, bone-specific alkaline phosphatase and OPG/RANKL ratio were significantly lower in them (p = 0.015, p = 0.031, p = 0.041, p = 0.0001). Patients with normal BMD were significantly taller than patients with low BMD (p = 0.035), while the number of active painful joints and swollen restricted mobility joints were significantly higher in patients with low BMD (p = 0.03, p = 0.02), with no significant difference regarding disease duration and bone turnover markers (p > 0.05).
Conclusions: JRA patients had lower BMD, higher frequency of low BMD (more prominent in the femoral neck) and higher OPG and RANKL levels compared with healthy children; suggesting that they may be at risk of developing premature osteoporosis and fractures later in life.

juvenile rheumatoid arthritis, DXA, BMD, RANKL, osteoprotegrin, children, osteoporosis

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