Childhood arthritis raises risk of broken bones

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Public release date: 8-May-2006

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Children's Hospital of Philadelphia

Childhood arthritis raises risk of broken bones

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.