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Baseline Bone Mineral Density Predicts Treatment Switch in Pediatric Chronic Nonbacterial Osteomyelitis: A Real-World
Muserref K Cuceoglu1, Merve Canturk2, Ezgi D Batu1
1Department of Pediatrics, Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine.
Objectives:
To assess whether baseline bone mineral density (BMD) influences treatment response and predicts the need for treatment switching in patients with chronic nonbacterial osteomyelitis (CNO).
Methods:
Demographics and clinical characteristics of patients, 25-OH vitamin D levels, radiologic findings (dual-energy X-ray absorptiometry, magnetic resonance imaging), and treatment switching were evaluated. First, patients were divided into 2 groups based on their treatment options: group 1 (NSAIDs/cDMARDs) and group 2 (TNFi/bisphosphonates). In addition, predictive factors for treatment switching were identified through binary logistic regression analysis in patients evaluated by DEXA.
Results:
Ninety-one patients (females, 54.9%) with CNO were included. BMD was analyzed in 48 (52.7%) patients and was normal in 20 (41.6%), osteoporotic in 19 (39.6%), and osteopenic in 9 (18.8%). Overall, 42 (68.9%) patients had vitamin D insufficiency/deficiency. In group 1 (n=10), none of the patients had osteoporosis, 3 (30%) had osteopenia, and 7 (70%) had normal BMD results, whereas in group 2 (n=38), 19 (50%) had osteoporosis and 6 (15.7%) had osteopenia ( p =0.016). Multivariate logistic regression analysis revealed that osteoporosis (OR=7.685, 95% CI: 1.679-26.562, p =0.009) and axial involvement (OR=2.625, 95% CI: 1.751-13.069, p =0.034) were the predictive factors for the treatment switching.
Conclusion:
Patients with normal BMD were more likely to respond well to first-line treatment. Osteoporosis and axial involvement are predictive factors for therapy switching in refractory disease. Although vitamin D deficiency is common in our cohort, its effect on relapse was not found. Monitoring of osteoporosis may be critical in the selection of second-line treatment.
