scholarly journals Bone mineral density in children with juvenile idiopathic arthritis after one year of treatment with etanercept

2018 ◽  
Vol 146 (5-6) ◽  
pp. 297-302
Author(s):  
Gordana Susic ◽  
Marija Atanaskovic ◽  
Roksanda Stojanovic ◽  
Goran Radunovic
Keyword(s):  
Bone Mineral Density ◽  
Juvenile Idiopathic Arthritis ◽  
Rheumatoid Factor ◽  
Bone Mineral ◽  
Mineral Metabolism ◽  
Z Score ◽  
Mineral Density ◽  
Bone Mineral Metabolism ◽  
Systemic Jia ◽  
One Year

Introduction/Objective. Juvenile idiopathic arthritis (JIA) is the most frequent chronic inflammatory, rheumatic disease of childhood, associated with disturbance of bone mineral metabolism, which develops gradually and progressively, and if untreated eventually leads to osteoporosis in adulthood. The aim of our study was to evaluate bone mineral density (BMD) in patients with JIA treated with etanercept over a period of one year. Methods. The prospective cohort study included 94 JIA patients (66 female, 28 male), their median age being 14.77 years. BMD was measured by dual-energy X-ray absorptiometry on the lumbar spine. Disease activity was assessed using the American College of Rheumatology Pedi 50 criteria. Results. After one year of treatment with etanercept, we found a statistically significant increment in all osteodensitometry variables (p < 0.001). Annual enhancement for the whole group was as follows: bone mineral content 15.8%, BMD 7.2%, BMDvol 4.2%. Z-score improved from -0.86 to -0.58 SD at the last visit, but decreased in rheumatoid factor-positive polyarthritis patients. Patients with systemic JIA had the lowest Z-score. Z-score correlated with functional disability level. BMD was lower in the group treated with glucocorticoids. Conclusion. Our results showed significant improvement of bone mineral density in children with JIA after one year of treatment with etanercept. Rheumatoid factor-positive and systemic JIA subtypes and treatment with glucocorticoids are the risk factors for impairing bone mineral metabolism.

P013 Serum osteoprotegerin and RANKL in patients with Juvenile Idiopathic Arthritis and their correlation with bone mineral density

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Radwa Helmy Shalaby ◽  
Elham Mohamed Kassem ◽  
Nagat Mohamed El-Gazzar ◽  
Sahar Ahmed Fathy Hammoudah ◽  
Amal Mohamed El-Barbary
Keyword(s):  
Bone Mineral Density ◽  
Juvenile Idiopathic Arthritis ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Disease Duration ◽  
Serum Levels ◽  
Z Score ◽  
Low Bone Mass ◽  
Mineral Density ◽  
Serum Rankl

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic arthropathy of childhood and is associated with low bone mass, and may hasten the onset of osteoporosis later in life1. Bone loss occurs because of an imbalance between osteoclasts-activating factors like receptor activator of nuclear factor-κB ligand (RANKL) and its inhibitor osteoprotegerin (OPG) 2. Dual energy X-ray absorptiometry (DXA) is the preferred method for measuring bone mineral density (BMD) in children and to identify and follow individuals at risk for fracture 3. The objective is the Evaluation of serum levels of osteoprotegerin and RANKL and their correlation with BMD in JIA patients. Methods Forty JIA patients (according to the revised classification criteria of ILAR) and 40 healthy children individually matched for age, sex and race were included in this study. Children excluded from the study were those with primary and secondary causes of osteoporosis (such as chronic illness). All patients were assessed clinically by: age, sex, body mass index, type of JIA, disease duration and disease activity (by Juvenile Arthritis Disease Activity Score; JADAS 10). The functional disability was assessed by the Childhood Health Assessment Questionnaire (CHAQ). Blood samples were collected from JIA patients and healthy controls to determine serum levels of OPG and RANKL by ELISA. DXA scans were done using GE Healthcare Lunar DPX, Madison, Wisconsin. Bone mineral density of the L1-L4 lumbar spine and total body less head (TBLH) was evaluated in g/cm2 and expressed as Z score for age, sex according to the reference data given for this equipment. Results The study included 40 patients (25 females) with a mean age of 11.14 years and median disease duration of 2.5 years. As regard JIA type, 45% of patients were oligoarticular, 32.5% were polyarticular, and 22.5% were systemic JIA. Median JADAS 10 was 13.95. Patients (especially polyarticular JIA) had significantly higher serum RANKL levels and lower serum OPG and OPG/RANKL ratio when compared with controls (with p-value &lt;0.001, 0.032 and &lt;0.001 respectively). A diagnosis of low BMD (BMD Z-score ≤ -2) was given in 25% of patients (15% polyarticular and 10% systemic) by DXA of lumbar spine, and 20% (10% polyarticular and 10% systemic) by DXA of TBLH. On the other hand, no patient was given a diagnosis of osteoporosis (BMD Z-score ≤ -2 and a significant fracture history). Low BMD at lumbar spine and TBLH was negatively correlated with serum RANKL while positively correlated with OPG/RANKL ratio. Moreover, low BMD at lumbar spine was positively correlated with serum OPG level Conclusion High RANKL and low OPG levels appear to be associated with low bone mass in JIA patients. Patients with JIA (especially polyarticular and systemic subtype) are at increased risk of low bone mineral mass. Disclosure of Interests None declared

MO199DENOSUMAB: NOVEL APPROACH TO TREATMENT OF OSTEOPOROSIS IN RENAL DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Rosita Greco ◽  
Agata Mollica ◽  
Francesco Zincone ◽  
Teresa Papalia
Keyword(s):  
Bone Mineral Density ◽  
Renal Disease ◽  
Bone Mineral ◽  
Renal Allograft ◽  
Mineral Metabolism ◽  
Transplant Recipients ◽  
Mineral Density ◽  
Anca Vasculitis ◽  
T Score ◽  
Bone Mineral Metabolism

Abstract Background and Aims Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor kappa-B ligand (RANKL), an osteoclast differentiating factor. It inhibits osteoclast formation, decrease bone resorption, increase bone mineral density (BMD), and reduce the risk of fracture. There is no restriction of its use in patients with renal disease, for whom biphosphonates are considered controindicated. The aim of our study was to evaluate the effectiveness in reducing facture risk and safety of Denosumab in patients with Osteoporosis and renal disease. Method This is a prospective analysis of 17 patients with Osteoporosis (average T-score below -2.5) admitted to our Nephrology Department for CKD in the last four years. in Vasculitis, Renal Allograft Recipients. Patients with severe Hyperparatiroidism were excluded. We estimated creatinine clearance (eGFR) using Cockcroft-Gault and classified levels of kidney function using the modified National Kidney Foundation classification of CKD. All patients were adequately supplemented with calcium and vitamin D before and while taking Denosumab 60 mg every 6 months. The primary endpoint is the change in bone mineral density (BMD) at one and two years. Secondary endpoints include changes in bone mineral metabolism parameters (Ca, P, PTHi, 25-OH VitD), incidence of fractures, and renal/allograft fuction at one and two years. Results The mean age was 52.5±4 years and 8/17 (47%) were females. N.13 patients (76.5%) were renal transplant recipients (RTR) on standard triple immunosoppression including steroids (prednisone 5 mg/day), CNI and MMF, with average eGFR 65.7±12.5 ml/min. N.2 patients (11.75%) were in hemodialysis. N.2 patients (11.75%) with Anca Vasculitis on steroid therapy and average eGFR 35.6±7.2 ml/min. All patients enrolled were with a BMD T-score of greater than -4.0 and less than -2.5. Only 2 patients had a history of fractures confirmed by a radiology report. Baseline parameters: calcium 9.8±0.32 mg/dl, phosphate 3.9±0.8 mg/dl, PTHi 137±91.0 ng/L, 25-OH VitD 18.3±8.9 ng/mL. From baseline at 1 month there were an increase in PTH and a decrease in calcemia in only 2 transplant recipients (CKD II and IV), that improved with an increased dose of Vit D. There were no significant difference in baseline bone mineral metabolism parameters to year 1 and 2 in all other patients. We found no difference in eGFR and proteinuria from baseline to 1 and 2 years in RTR and ANCA vasculitis. Significant improvement in T-score was observed at 1 year and 2 years (&lt; -1) in all patients. No one discontinued therapy for adverse events. Conclusion Denosumab may have advantages in patients with kidney dysfunction, because not excreted by the kidney and there is no need for dose adjustment. This prospective study showed a significant improvement in osteoporosis (at Dexa mean T-score ≤ -1), but particular attention should be paid to ensuring that patients are calcium and Vitamin D replete.

Bone mineral metabolism, bone mineral density in patients with chronic pancreatitis

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S107
Author(s):  
Ancuta Didita ◽  
Mihaela Dranga ◽  
Irina Ungureanu ◽  
Cristina Cijevschi Prelipcean ◽  
Catalina Mihai
Keyword(s):  
Bone Mineral Density ◽  
Chronic Pancreatitis ◽  
Bone Mineral ◽  
Mineral Metabolism ◽  
Mineral Density ◽  
Bone Mineral Metabolism

scholarly journals The proportion of bone mineral density in children with high risk acute lymphoblastic leukemia after 6- and 12-month chemotherapy maintenance phase

2016 ◽  
Vol 50 (6) ◽  
pp. 365
Author(s):  
Mira Christiyani Santoso ◽  
Endang Windiastuti ◽  
Alan R. Tumbelaka
Keyword(s):  
Bone Mineral Density ◽  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Bone Mineral ◽  
Calcium Ion ◽  
Mineral Metabolism ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase ◽  
Z Score ◽  
Mineral Density

Background Low bone mineral density (BMD) value is one of the current concerns in acute lymphoblastic leukemia (ALL) patients. Some risk factors including use of chemotherapeutic drugs, nutritional status, phy sical activities, and progression of disease are suspected as the predisposing factors for development of osteopenia and osteoporosis.Objectives To obtain the proportion of BMD z-score, level of calcium ions, and 25 (OH)D3 in children 'With high risk ALL after 6 and 12 months chemotherapy maintenance phase.Methods We conducted a cross-sectional comparative study from May 2008 to May 2010. Subjects were high risk ALL patients aged 5-18 years old who had completed the 6 or 12 months chemotherapy maintenance phase. We measured 25 (OH) D3 level, calcium ion level, and BMD using electro chemi-luminescence immunoassay, ion selective electrode, and dual x-ray absorptiometry, respectively.Results There were 40 subjects who enrolled this study. The incidence of hypocalcemia and vitamin D deficiency were 33/40 and 40/40, respectively. The mean calcium ion levels, 25 (OH)D3 level, and BMD z􀁏score values in six months groups were 1.1 (0.1 SD) mmol/L, 21.3 (2 SD) ng/L, -0.7 (0.8 SD), respectively, while in the 12 months group, the values were 1.1 (0.0 SD) mmol/L, 21(2.2 SD) ng/L, -1.7 (0.6 SD), respectively (P=0.478). Body mass index (BMI) and corticosteroid cumulative dose is correlated \\lith the low BMD values in L1-L4.Conclusion The bone mineral metabolism disorder marked with the low levels of calcium, 25 (OH)D3 and osteopenia was observed in ALL patients who underwent chemotherapy. The proportion of the BMD z-score value, calcium ion level, and 25 (OH) D3 in the two groups were not statistically significant.

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