Childhood Arthritis Raises Risk Of Broken Bones

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Childhood Arthritis Raises Risk Of Broken Bones

Article Date: 12 May 2006 - 7:00am (PDT)

http://www.medicalnewstoday.com/medicalnews.php?newsid=43062

Childhood arthritis increases the risk of fractures, particularly during

adolescence, according to a large study of British patient records. The

researchers say that more targeted treatments promoting bone health would

benefit patients with childhood-onset arthritis throughout their lifespan.

In addition to raising the risk of fracture during childhood, the

researchers also found that childhood-onset arthritis potentially heightens

fracture risk after age 45.

A research team led by pediatric rheumatologist Jon M. Burnham, M.D., of The

Children's Hospital of Philadelphia and the University of Pennsylvania,

analyzed the medical records of 1,959 patients in the United Kingdom who

first experienced arthritis between ages one and 19. The researchers

compared those patients to a larger control group of 207,000 patients in a

primary care database.

The study appeared online in the ls of the Rheumatic Diseases on April

21. It was the first research to examine, in a population-based study, the

risk of fractures in childhood arthritis patients.

Juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid

arthritis, is the most common pediatric rheumatic disease, affecting

approximately one in 1,000 U.S. children. It was already known that low bone

mass occurs in patients with JIA, because of risk factors such as chronic

inflammation, delayed puberty, malnutrition, weakness, inactivity and

treatment with steroid medications.

" The goal of this study was to determine if the bone abnormalities seen in

JIA are clinically significant, resulting in higher fracture rates, and that

is exactly what we found, " said Dr. Burnham. " The low bone mass in JIA is

associated with skeletal fragility, and causes both short-term and long-term

health problems. Someone who fails to attain peak bone mass during

adolescence and young adulthood is more vulnerable to fractures in later

life, when bone mass inexorably declines. "

Fractures are not unusual in healthy, active children, and the researchers

compared the records of patients who had juvenile-onset arthritis with those

of control subjects. Their data source was the United Kingdom General

Practice Research Database, representing primary care records from 1987 to

2002.

The researchers found that 6.7 percent of patients with JIA sustained first

fractures, compared to 3.3 percent of control subjects with first fractures,

during an average follow-up period of four years. The comparative risk for

patients with arthritis was highest at ages 10 to 15 and peaked again after

age 45. Patients with arthritis were significantly more likely than controls

to suffer fractures in their arm and leg bones.

Dr. Burnham added that the study findings should encourage physicians caring

for children with arthritis to more closely monitor their patients for signs

of osteoporosis, and to focus on nutritional steps that promote bone health,

such as increasing regular intake of calcium and vitamin D.

Because bone health is affected by a combination of factors, including

inflammation, inactivity, delayed puberty, impaired nutrition and the use of

steroid medications, he added, further studies should concentrate on

determining how JIA interacts with these risk factors, and how specific

therapies might benefit JIA patients. Dr. Burnham is currently leading

multidisciplinary research on bone and muscle strength in JIA and other

inflammatory diseases.

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The Nickolett Foundation for JRA Research funded the study. Dr. Burnham's

co-authors were B. Leonard, M.D., of The Children's Hospital of

Philadelphia; and D. , M.D., e Shults, Ph.D., and

Weinstein, Ph.D., of the University of Pennsylvania School of Medicine. All

the authors are on the faculty of the Penn School of Medicine and of the

Center for Clinical Epidemiology and Biostatistics at Penn.

About The Children's Hospital of Philadelphia: The Children's Hospital of

Philadelphia was founded in 1855 as the nation's first pediatric hospital.

Through its long-standing commitment to providing exceptional patient care,

training new generations of pediatric healthcare professionals and

pioneering major research initiatives, Children's Hospital has fostered many

discoveries that have benefited children worldwide. Its pediatric research

program is among the largest in the country, ranking second in National

Institutes of Health funding. In addition, its unique family-centered care

and public service programs have brought the 430-bed hospital recognition as

a leading advocate for children and adolescents. For more information, visit

http://www.chop.edu/.