Inoue Yuzaburo, Mitsunaga Kanako, Yamamoto Takeshi, Chiba Koki, Yamaide Fumiya, Nakano Taiji, Morita Yoshinori, Yamaide Akiko, Suzuki Shuichi, Arima Takayasu, Yamaguchi Ken-Ichi, Tomiita Minako, Shimojo Naoki, Kohno Yoichi
Department of Pediatrics, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan.
Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
Pediatr Rheumatol Online J. 2018 Jun 18;16(1):36. doi: 10.1186/s12969-018-0258-5.
Bisphosphonates are recommended for use as first-line therapy for the prevention and treatment of glucocorticoid-induced osteoporosis in adults. However, the appropriate usage of bisphosphonates for the prevention or treatment of glucocorticoid-induced osteoporosis in children remains unclear.
We performed a cross-sectional study to clarify the factors associated with the development of glucocorticoid-induced bone loss and osteoporosis in patients with childhood-onset rheumatic disease and to investigate the impact of the early use of alendronate. We recruited 39 patients with childhood-onset rheumatic disease who were evaluated to detect bone loss or osteoporosis at 3 months to 1.5 years after the initiation of treatment. The primary outcome of the study was the presence of bone loss or osteoporosis at the initial evaluation of the bone mineral density after at least 3 months of glucocorticoid therapy.
Bone loss and a history of fracture were found in 56 and 18% of the participants, respectively. Weekly oral alendronate therapy (median, 25.4 mg/m) had been started by the time of the evaluation of osteoporosis in 46% of the participants and within 3 months after the start of glucocorticoid in 31% of the participants. There were no significant differences between the participants with bone loss (wBL group) and without bone loss (w/oBL group) in terms of gender, primary disease, or the age at the onset of primary disease. In terms of glucocorticoid use, there was no significant difference in the age at the start of glucocorticoid therapy, the length of glucocorticoid use, or the dose of glucocorticoids. The proportion of patients in the w/oBL group who received alendronate within 3 months after the start of glucocorticoid therapy was significantly greater than that in the wBL group. In the logistic regression analysis, only "alendronate therapy within 3 months after the start of glucocorticoid therapy" had a statistically significant effect on the development of bone loss (OR, 0.08; 95% CI, 0.02-0.43). The analysis did not reveal any factors associated with the development of osteoporosis.
The early use of alendronate may have a preventive effect against the development of bone loss in glucocorticoid-treated patients with childhood-onset rheumatic disease.
双膦酸盐被推荐作为成人糖皮质激素诱导的骨质疏松症预防和治疗的一线疗法。然而，双膦酸盐在儿童糖皮质激素诱导的骨质疏松症预防或治疗中的恰当用法仍不明确。
我们开展了一项横断面研究，以阐明儿童期起病的风湿性疾病患者中糖皮质激素诱导的骨质流失和骨质疏松症发生发展的相关因素，并研究早期使用阿仑膦酸钠的影响。我们招募了39例儿童期起病的风湿性疾病患者，这些患者在开始治疗后3个月至1.5年接受评估以检测骨质流失或骨质疏松症。该研究的主要结局是在糖皮质激素治疗至少3个月后首次评估骨密度时是否存在骨质流失或骨质疏松症。
分别有56%和18%的参与者存在骨质流失和骨折史。在评估骨质疏松症时，46%的参与者已开始每周口服阿仑膦酸钠治疗（中位数为25.4mg/m），31%的参与者在开始使用糖皮质激素后3个月内开始治疗。在骨质流失的参与者（wBL组）和无骨质流失的参与者（无BL组）之间，在性别、原发性疾病或原发性疾病发病年龄方面没有显著差异。在糖皮质激素使用方面，糖皮质激素治疗开始时的年龄、糖皮质激素使用时长或糖皮质激素剂量没有显著差异。无BL组中在开始使用糖皮质激素治疗后3个月内接受阿仑膦酸钠治疗的患者比例显著高于wBL组。在逻辑回归分析中，只有“开始使用糖皮质激素治疗后3个月内进行阿仑膦酸钠治疗”对骨质流失的发生发展具有统计学显著影响（比值比，0.08；95%置信区间，0.02 - 0.43）。该分析未揭示与骨质疏松症发生发展相关的任何因素。
早期使用阿仑膦酸钠可能对儿童期起病的风湿性疾病且接受糖皮质激素治疗的患者骨质流失的发生发展具有预防作用。
