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Low bone mineral density is present in newly diagnosed paediatric systemic lupus erythematosus patients
  1. Siok Hoon Lily Lim1,
  2. Susanne M Benseler1,
  3. Pascal N Tyrrell1,
  4. Martin Charron1,
  5. Elizabeth Harvey2,
  6. Diane Hebert2,
  7. Earl D Silverman1,3
  1. 1Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  2. 2Nuclear Medicine, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  3. 3Departments of Paediatrics and Immunology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Earl D Silverman, Ho Family Chair in Autoimmune Diseases, Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; earl.silverman{at}sickkids.ca

Abstract

Objectives The objectives of this study were to (1) determine the prevalence of low bone mineral density (BMD) in a large prospective cohort of newly diagnosed patients with paediatric systemic lupus erythematosus (pSLE) and (2) identify risk factors associated with low BMD.

Methods Single-centre cohort study of 80 children and adolescents who underwent a dual-energy x-ray absorptiometry within 3 months of diagnosis. Low lumbar spine (LS) BMD was defined as z score ≤−2.0. BMD was correlated with baseline demographic, clinical and laboratory markers of disease activity and biochemical markers of bone health. Risk factors of BMD were evaluated with univariable and multivariable linear and logistic regression analyses.

Results Low BMD at any site was found in 15% of newly diagnosed pSLE patients. LS BMD was associated with body mass index (BMI) z score and corrected calcium (r2=0.31, p<0.0001). Hip BMD was associated with BMI z score and intact parathyroid hormone (iPTH) (r2=0.26, p=0.002). Higher BMI z score was protective against low BMD at any site (OR 0.35).

Conclusions One in six newly diagnosed pSLE patients had low BMD (at any site). Low BMI z score, low calcium and high iPTH identified children at risk for low BMD at diagnosis of pSLE.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Hospital for Sick Children.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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