Background Osteoporosis is one of the most important and common complications in children with Juvenile Chronic Arthritis (JCA). Osteoporosis in JCA has a multifactorial origin. Reduced or absent physical activity, decreased production of endogenous vitamin D, anaemia and drug treatment, especially steroid treatment are thought to be possible mechanisms of osteoporosis in children with JCA.
Objectives The aim of this study was to evaluate the effect of calcitonin and calcium treatment on bone mineral status in patients with JCA.
Methods According to EULAR criteria 16 patients (7 male, 9 female) with JCA (2 patients with systemic, 2 patients with oligoarticular and 12 patients with polyarticular type) and 13 age and sex similar healthy controls (8 male, 5 female) were included in the study. The mean age of the patients and control groups were 10,12 ± 3,80 and 10,2 ± 3,26 years respectively. Patients with JCA were randomly treated for 6 months with either 50 IU/day salmon calcitonin administered intranasal and 500 mg calcium per day per oral (Group 1) or 500 mg/day calcium only (Group 2) to determine their effect on bone status. Bone mineral density (BMD) of the lumbar spine at the L1-L4 level was measured by dual energy x-ray absorptiometry (Hologic QDR-4500 A). Disease activity was determined by clinical and laboratory evaluation (serum erythrocyte sedimentation rate and C reactive protein levels), and Juvenile Arthritis Functional Assessment Report (JAFAR). Data from BMD measurements were obtained at baseline and 6 months later.
Results The mean age and the duration of disease for groups 1&2 were 9,4 ± 4,31 years and 41,10 ± 42,29 months and 11,33 ± 2,65 years and 40,66 ± 33,31 months respectively. The mean baseline BMD results were 0.458 ± 0.157 gr/cm² in Group 1, 0.580 ± 0.137 gr/cm² in Group 2 and 0.599 ± 0.096 gr/cm² in control group. BMD values of the JCA group were significantly lower than the control group (p = 0,038). In both treatment groups (Group 1 and Group 2) there were an increase in BMD values (p1 = 0,05 and p2 = 0,028 respectively). As the increments were compared the difference in between was not statistically significant (p > 0.05).
Conclusion Our results suggest that children with JCA would benefit from calcium supplementation and calcitonin treatment. No adverse effects were observed in both treatment groups during the follow-up period.
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