Department of Dermatology and Allergology, Wilhelmina's Children's Hospital, University Medical Center Utrecht, The Netherlands.
J Am Acad Dermatol. 2010 Nov;63(5):824-31. doi: 10.1016/j.jaad.2009.12.015. Epub 2010 Sep 17.
Low bone mineral density (BMD) has been reported in 30.4% of adult patients with atopic dermatitis (AD).
The aim of this study was to determine the prevalence of low BMD in children with moderate to severe AD and to investigate the relation between BMD and corticosteroid and cyclosporine therapy.
Lumbar spine BMD was measured by dual-energy X-ray absorptiometry in 60 children (age 5-16 years) with moderate to severe AD. BMD (in g/cm(2)) was expressed in Z-scores, the number of SD above or below the mean value of an age- and sex-matched reference population. In children, low BMD was defined as a Z-score less than -2. Information on lifestyle parameters and bone fractures were collected by use of a standardized questionnaire. The cumulative dose of corticosteroids and cyclosporine therapy was calculated for the previous 5-year period.
Three patients (5%) had low BMD; one patient (1.7%) had osteoporosis. The observed prevalence of low BMD in this study (6.7%; 95% confidence interval 1.8%-16.2%) does not differ from the expected prevalence of low BMD in the general population (P = .06). Overall, use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD (Z-score). When children received additional systemic treatment (oral corticosteroids and/or cyclosporine) in the previous 5 years, BMD decreased, although the decrease was not statistically significant. Correction for lifestyle parameters did not change these associations.
The number of patients studied was limited. The cumulative dose of corticosteroids and cyclosporine therapy was only registered for the previous 5 years, and relatively low amounts of topical corticosteroids were used. The definition of low BMD differs between adults (Z-score < -1) and children (Z-score < -2). Because there is no Dutch BMD reference population for children, normative BMD references were obtained from a different population (US children).
Low BMD did not occur more frequently in this population of children with moderate to severe AD compared with the general population. Use of topical corticosteroids in the previous 5 years was not associated with a decrease in BMD.
据报道，30.4%的特应性皮炎（AD）成年患者存在骨矿物质密度（BMD）降低。
本研究旨在确定中重度 AD 患儿中低 BMD 的患病率，并探讨 BMD 与皮质类固醇和环孢素治疗之间的关系。
通过双能 X 射线吸收法测量 60 例（5-16 岁）中重度 AD 患儿的腰椎 BMD。BMD（以 g/cm(2)表示）用 Z 分数表示，即与年龄和性别匹配的参考人群平均值相比的标准差数。在儿童中，低 BMD 定义为 Z 分数小于-2。通过使用标准化问卷收集生活方式参数和骨折的信息。计算了过去 5 年皮质类固醇和环孢素治疗的累积剂量。
3 例（5%）患儿存在低 BMD，1 例（1.7%）患儿存在骨质疏松症。本研究观察到的低 BMD 患病率（6.7%；95%置信区间 1.8%-16.2%）与一般人群中低 BMD 的预期患病率无差异（P =.06）。总体而言，过去 5 年中局部使用皮质类固醇与 BMD 降低无关（Z 分数）。当患儿在过去 5 年内接受额外的全身治疗（口服皮质类固醇和/或环孢素）时，BMD 下降，尽管差异无统计学意义。对生活方式参数进行校正并未改变这些关联。
研究的患者数量有限。皮质类固醇和环孢素治疗的累积剂量仅记录了过去 5 年，且局部使用的皮质类固醇相对较少。低 BMD 的定义在成人（Z 分数< -1）和儿童（Z 分数< -2）之间存在差异。由于荷兰没有儿童 BMD 参考人群，因此采用了来自不同人群（美国儿童）的正常 BMD 参考值。
与一般人群相比，该中重度 AD 患儿人群中低 BMD 的发生率无增加。过去 5 年内使用局部皮质类固醇与 BMD 降低无关。
