Burnham Jon M, Leonard Mary B
Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, CHOP North, Room 1564, Philadelphia, PA 19104, USA.
Curr Rheumatol Rep. 2004 Feb;6(1):70-8. doi: 10.1007/s11926-004-0086-0.
Children with rheumatic disorders have multiple risk factors for impaired bone health, including delayed growth and development, malnutrition, decreased weight-bearing activity, inflammation, and glucocorticoid therapy. The impact of rheumatic disease during childhood may be immediate, resulting in fragility fractures, or delayed, because of suboptimal peak bone mass accrual. Recent years have seen increased interest in the effects of pediatric rheumatic disorders on bone mineralization, such as juvenile rheumatoid arthritis, systemic lupus erythematosus, and juvenile dermatomyositis. This review outlines the expected gains in bone size and mass during childhood and adolescence, and summarizes the advantages and disadvantages of available technologies for the assessment of skeletal growth and fragility in children. The varied threats to bone health in pediatric rheumatic disorders are reviewed, with emphasis on recent insights into the molecular mechanisms of inflammation-induced bone resorption. The literature assessing bone deficits and risk factors for impaired bone health in pediatric rheumatic disorders is reviewed, with consideration of the strengths and limitations of prior studies. Finally, future research directions are proposed.
患有风湿性疾病的儿童存在多种影响骨骼健康的风险因素，包括生长发育迟缓、营养不良、负重活动减少、炎症以及糖皮质激素治疗。儿童期风湿性疾病的影响可能是即时的，导致脆性骨折，也可能是延迟的，因为峰值骨量积累不理想。近年来，人们对小儿风湿性疾病对骨矿化的影响越来越感兴趣，如幼年类风湿关节炎、系统性红斑狼疮和幼年皮肌炎。本综述概述了儿童和青少年时期骨骼大小和骨量预期的增长情况，并总结了评估儿童骨骼生长和脆性的现有技术的优缺点。本文回顾了小儿风湿性疾病中对骨骼健康的各种威胁，重点是对炎症诱导骨吸收分子机制的最新见解。本文回顾了评估小儿风湿性疾病中骨量不足和骨骼健康受损风险因素的文献，并考虑了先前研究的优势和局限性。最后，提出了未来的研究方向。
