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Published on: January 29, 2018
Low bone mineral density in Thai children with systemic lupus erythematosus: prevalence and risk factors
Ankanee Chanakul1, Suriyaphon Khunrattanaphon2, Tawatchai Deekajorndech1
1Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Insights
Low bone mass is common in children with systemic lupus erythematosus (SLE), affecting 40% at diagnosis and increasing over time. Higher corticosteroid doses may be linked to this complication in pediatric SLE patients.
Area of Science:
- Pediatric Rheumatology
- Bone Metabolism
- Systemic Lupus Erythematosus
Background:
- Improved survival in childhood systemic lupus erythematosus (SLE) shifts focus to long-term complications like low bone mass and osteoporosis.
- Risk factors for low bone mineral density (BMD) in adult SLE include age, inflammation, and corticosteroid use.
Purpose of the Study:
- To determine the prevalence of low bone mineral density (BMD) in Thai children diagnosed with SLE.
- To identify risk factors associated with low BMD in this pediatric cohort.
Main Methods:
- Retrospective review of 60 Thai children with SLE.
- Dual-energy X-ray absorptiometry (DXA) performed at initial visit and follow-up.
- Low BMD defined as a BMD z-score ≤ -2.0; logistic regression used for risk factor analysis.
Main Results:
- Prevalence of low BMD was 40% at initial diagnosis, increasing to 55% during follow-up.
- Significant decreases in hip and lumbar BMD z-scores were observed over time.
- Higher cumulative steroid dose showed a trend towards association with low BMD (OR=1.08, P=0.050).
Conclusions:
- Low bone mineral density (BMD) is prevalent at diagnosis in Thai children with SLE and worsens over time.
- Cumulative corticosteroid dose may be a risk factor, though not statistically significant in this sample.
- Further research is needed to confirm risk factors and develop interventions for low BMD in pediatric SLE.
Background:
Improvement of disease recognition and management has increased the survival of children with systemic lupus erythematosus (SLE), but has shifted the morbidity focus toward long-term complications, such as low bone mass and osteoporosis. Studies in adults with SLE show older age, chronic inflammation, and corticosteroid therapy are risk factors for low bone mineral density (BMD) and osteoporosis.
Objectives:
To determine the prevalence of and identify risk factors associated with low BMD in Thai children with SLE.
Methods:
We conducted a retrospective review of demographic data and clinical variables for a cohort of 60 Thai children with SLE who underwent 2 dual-energy X-ray absorptiometry (DXA) at their initial examination and later follow-up. We considered a BMD z score ≤ -2.0 to indicate low BMD. Binary logistic regression was used to assess risk factors potentially associated with low BMD.
Results:
The prevalence of low BMD at the first visit was 40% and increased to 55% over follow-up. We found a significantly decreased hip BMD z score (median difference -0.25, 95% confidence interval [CI] -0.40 to -0.05; P = 0.016) and lumbar BMD z score (median difference -0.49, 95% CI -0.69 to -0.28; P < 0.001) over time. The cumulative steroid dose tended to be higher for patients with low BMD (adjusted odds ratio [OR] = 1.08, 95% CI 1.00 to 1.17; P = 0.050).
Conclusion:
Low BMD has a 40% prevalence in Thai children newly diagnosed with SLE and progresses significantly over time. Higher cumulative corticosteroid dose tended to be associated with a low BMD, but we did not find a significant risk in this small sample.
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