Zhang Yujuan, Milojevic Diana
Pediatric Rheumatology Division, Floating Hospital for Children at Tufts Medical Center, 800 Washington Street, #190, Boston, MA, 02111, USA.
Paediatr Drugs. 2017 Jun;19(3):193-211. doi: 10.1007/s40272-017-0219-3.
Bone health in children with rheumatic conditions may be compromised due to several factors related to the inflammatory disease state, delayed puberty, altered life style, including decreased physical activities, sun avoidance, suboptimal calcium and vitamin D intake, and medical treatments, mainly glucocorticoids and possibly some disease-modifying anti-rheumatic drugs. Low bone density or even fragility fractures could be asymptomatic; therefore, children with diseases of high inflammatory load, such as systemic onset juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, and those requiring chronic glucocorticoids may benefit from routine screening of bone health. Most commonly used assessment tools are laboratory testing including serum 25-OH-vitamin D measurement and bone mineral density measurement by a variety of methods, dual-energy X-ray absorptiometry as the most widely used. Early disease control, use of steroid-sparing medications such as disease-modifying anti-rheumatic drugs and biologics, supplemental vitamin D and calcium, and promotion of weight-bearing physical activities can help optimize bone health. Additional treatment options for osteoporosis such as bisphosphonates are still controversial in children with chronic rheumatic diseases, especially those with decreased bone density without fragility fractures. This article reviews common risk factors leading to compromised bone health in children with chronic rheumatic diseases and discusses the general approach to prevention and treatment of bone fragility.
患有风湿性疾病的儿童的骨骼健康可能会因多种因素而受到损害，这些因素与炎症性疾病状态、青春期延迟、生活方式改变（包括身体活动减少、避免日晒、钙和维生素D摄入不足）以及医学治疗（主要是糖皮质激素，可能还有一些改善病情的抗风湿药物）有关。低骨密度甚至脆性骨折可能没有症状；因此，患有高炎症负荷疾病的儿童，如全身型幼年特发性关节炎、幼年皮肌炎、系统性红斑狼疮，以及那些需要长期使用糖皮质激素的儿童，可能会从常规的骨骼健康筛查中受益。最常用的评估工具是实验室检测，包括血清25-羟基维生素D测量以及通过多种方法进行的骨密度测量，双能X线吸收法是使用最广泛的。早期疾病控制、使用如改善病情的抗风湿药物和生物制剂等减少类固醇用量的药物、补充维生素D和钙，以及促进负重体育活动，有助于优化骨骼健康。对于骨质疏松症的其他治疗选择，如双膦酸盐，在患有慢性风湿性疾病的儿童中，尤其是那些骨密度降低但没有脆性骨折的儿童中，仍然存在争议。本文综述了导致慢性风湿性疾病儿童骨骼健康受损的常见危险因素，并讨论了预防和治疗骨脆性的一般方法。
