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Bone status evaluation with calcaneal ultrasound in children with chronic rheumatic diseases. A one year followup
Fernanda Falcini1, Giuseppe Bindi, Gabriele Simonini
1Department of Pediatrics, Rheumatology Unit, University of Florence, Italy. falcini@unifi.it
Insights
Quantitative ultrasound effectively monitors bone health in children with chronic rheumatic diseases (CRD). Alendronate improved bone status, while steroids showed a decrease, highlighting treatment impacts on pediatric bone density.
Area of Science:
- Pediatric Rheumatology
- Bone Metabolism
- Quantitative Ultrasound Imaging
Background:
- Children with chronic rheumatic diseases (CRD) often experience impaired bone status.
- Monitoring bone health is crucial for managing long-term outcomes in pediatric CRD patients.
Purpose of the Study:
- To assess bone status in children with CRD at baseline and after one year using quantitative ultrasound.
- To evaluate the impact of different therapeutic regimens on bone parameters.
Main Methods:
- Quantitative ultrasound (Broadband Ultrasound Attenuation - BUA) was performed on the calcaneus of 67 children (2.80-18.10 years) with CRD.
- Patient groups included juvenile idiopathic arthritis, juvenile dermatomyositis, and systemic lupus erythematosus.
- Bone status was analyzed in relation to medication, including NSAIDs, methotrexate, steroids, and alendronate.
Main Results:
- Children with CRD exhibited significantly lower baseline BUA values and Z scores compared to controls.
- Overall BUA values increased significantly after one year, but Z scores did not change.
- Children receiving steroids showed decreased BUA and Z scores, while those on alendronate demonstrated significant increases in both BUA and Z scores.
Conclusions:
- Quantitative ultrasound of the calcaneus is a valuable tool for assessing and monitoring bone status in pediatric CRD.
- Therapeutic interventions significantly influence bone health outcomes in children with CRD.
- Alendronate shows promise in improving bone density, whereas steroid use may negatively impact bone status.
Objective:
To evaluate at baseline and after one year the bone status in children with chronic rheumatic diseases (CRD) using quantitative ultrasound techniques.
Methods:
We evaluated bone status in 67 children, 52 female, 15 male, age range 2.80 to 18.10 years; 46 juvenile idiopathic arthritis, 11 juvenile dermatomyositis, and 10 systemic lupus erythematosus. Twenty-seven of 67 patients were taking only nonsteroidal antiinflammatory drugs (NSAID), 11 were given NSAID and methotrexate (MTX), 15 were also receiving steroids (prednisone), and 14 patients were given steroids and alendronate. Broadband ultrasound attenuation (BUA) by bone was determined at the left calcaneus using two 12.5 mm diameter, 1 MHz transducers mounted in hand-held calipers linked to a pediatric contact ultrasound bone analyzer.
Results:
At baseline in the whole patient group mean BUA values and Z scores were significantly lower than in controls: 41.84 +/- 21.64 vs 61.69 +/- 17.42 dB/MHz (p < 0.001); Z score -0.91 +/- 1.07 vs 0.09 +/- 0.62 in controls (p < 0.001). At one year followup in the patient group BUA values were significantly increased compared to baseline (BUA 46.43 +/- 21.51 dB/MHz; p = 0.002); no significant difference was found in Z score. The 15 children receiving steroids in addition to NSAID and MTX showed a decrease in BUA value at one year (NS), while Z scores were significantly reduced compared to baseline (-1.45 +/- 1.40 vs -1.08 +/- 1.11; p < 0.05). The 14 patients in the group receiving NSAID and MTX who also received alendronate showed significant increases in BUA (56.93 +/- 19.32 vs 44.21 +/- 15.67; p < 0.001) and Z score (-0.87 +/- 1.19 vs -1.56 +/- 0.82; p < 0.002).
Conclusion:
Contact ultrasound bone analysis at the calcaneus is a useful tool in the assessment and monitoring of bone status in children with CRD.
