Childhood-Onset Arthritis Increases Fracture Risk

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Childhood-Onset Arthritis Increases Fracture Risk

http://www.medpagetoday.com/Rheumatology/Arthritis/tb/3265

MedPage Today Action Points

a.. Explain to interested patients that this study found

that a history of juvenile onset arthritis seems to be a risk factor for

fracture in adolescence and after the age of 45.

b.. Advise measures to promote bone health among

pediatric patients with arthritis, including regular physical activity and

adequate intake of calcium and vitamin D.

Juvenile-onset arthritis seems to confer an increased fracture risk to

patients when they grow up, according to a large retrospective study.

Compared with a control group of more than 207,000 patients

without childhood-onset arthritis, 1,939 patients who had the condition were

more likely to suffer a bone fracture across all age groups, said Dr. Jon M.

Burnham, M.D., of the Children's Hospital of Philadelphia here.

Fractures were generally more common during the highly-active

adolescent years and also during middle age, when bone mass begins to

decline, Dr. Burnham and colleagues reported online in ls of the

Rheumatic Diseases.

Overall, 6.7% of the juvenile-onset arthritis group broke a bone

during the study compared with 3.3% of the control group (P<.001).

The elevated risk was especially dramatic for those ages 10 to

15 (relative risk=3.13; 95% confidence interval=2.21 to 4.43) and for those

45 and older (RR=3.97; 95% CI=2.23 to 6.59), the study found.

The study used data from the United Kingdom General Practice

Research Database, which was chosen because it is a top source for fracture

data and because it contains a wide age range of patients, Dr. Burnham said.

The analysis included nearly 2,000 patients diagnosed with juvenile-onset

arthritis from 1987 through 2002. These patients ranged in age from one to

96, and all were followed for an average of four years.

The median age at arthritis diagnosis was 10.9. There were a

total of 129 (6.7%) first fractures in patients with arthritis compared with

6,910 (3.3%) in controls over a median follow-up of 3.90 and 3.95 years,

respectively, in those with arthritis and controls.

The incidence rate ratios (95% confidence interval) for first

fracture among those with arthritis, compared with controls, according to

the age at the start of follow-up were 1.49 (0.91 to 2.31) for age less than

10 years; 3.13 (2.21 to 4.33) at 10-15 years; 1.75 (1.18 to 2.51) at 15-20

years; 1.40 (0.91 to 2.08) at 20-45 years; and 3.97 (2.23 to 6.59) at

greater than 45 years.

Previous research had established that patients with juvenile

idiopathic arthritis tend to have weaker bones, but the current study is the

first to document an increased fracture risk in a large cohort of these

patients as adults.

The results suggested that clinicians should be especially

vigilant in monitoring patients with a history of childhood-onset arthritis

for osteoporosis, Dr. Burnham and colleagues wrote.

The study found no significant associations between use of

arthritis drugs and fracture risk, including disease-modifying,

anti-rheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs

(NSAIDs), or glucocorticoids.

The study suggested that a patient with a history of childhood

arthritis and multiple fractures-or even a single severe fracture such as a

vertebral compression-should be evaluated for osteoporosis with a bone

mineral density scan, Dr. Burnham said.

However, such scans are challenging to perform and difficult to

interpret in pediatric patients, and diagnosing osteoporosis in this patient

group will likely require the help of an orthopedic surgeon or a pediatric

endocrinologist, he added.

Because children with arthritis are at risk for developing

suboptimal bone mass during the peak growth years of adolescence and early

adulthood, strategies to promote bone health should be promoted in this

group, including regular physical activity and adequate intake of calcium

and vitamin D, Dr. Burnham advised.

In the United States, juvenile-onset arthritis affects about one

in 1,000 children. Of these, 20% to 30% may develop osteoporosis, Dr.

Burnham said.

Primary source: ls of the Rheumatic Diseases

Source reference:

Jon Burnham et al. " Childhood onset arthritis is associated with

an increased risk of fracture: a population based study using the General

Practice Research Database. " ls of the Rheumatic Diseases 2006. Advanced

online publication April 21, 2006.

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the

University of Pennsylvania School of Medicine.

May 10, 2006

[Guest guest]

This is some info on fractures and does mention the spinal issues. Michele

( 22, spondy)

________________________________

From: [mailto: ] On Behalf Of

Georgina

Sent: Saturday, June 24, 2006 7:27 PM

*JRA List

Subject: Childhood-Onset Arthritis Increases Fracture Risk

Childhood-Onset Arthritis Increases Fracture Risk

http://www.medpagetoday.com/Rheumatology/Arthritis/tb/3265

MedPage Today Action Points

a.. Explain to interested patients that this study found

that a history of juvenile onset arthritis seems to be a risk factor for

fracture in adolescence and after the age of 45.

b.. Advise measures to promote bone health among

pediatric patients with arthritis, including regular physical activity and

adequate intake of calcium and vitamin D.

Juvenile-onset arthritis seems to confer an increased fracture risk to

patients when they grow up, according to a large retrospective study.

Compared with a control group of more than 207,000 patients

without childhood-onset arthritis, 1,939 patients who had the condition were

more likely to suffer a bone fracture across all age groups, said Dr. Jon M.

Burnham, M.D., of the Children's Hospital of Philadelphia here.

Fractures were generally more common during the highly-active

adolescent years and also during middle age, when bone mass begins to

decline, Dr. Burnham and colleagues reported online in ls of the

Rheumatic Diseases.

Overall, 6.7% of the juvenile-onset arthritis group broke a bone

during the study compared with 3.3% of the control group (P<.001).

The elevated risk was especially dramatic for those ages 10 to

15 (relative risk=3.13; 95% confidence interval=2.21 to 4.43) and for those

45 and older (RR=3.97; 95% CI=2.23 to 6.59), the study found.

The study used data from the United Kingdom General Practice

Research Database, which was chosen because it is a top source for fracture

data and because it contains a wide age range of patients, Dr. Burnham said.

The analysis included nearly 2,000 patients diagnosed with juvenile-onset

arthritis from 1987 through 2002. These patients ranged in age from one to

96, and all were followed for an average of four years.

The median age at arthritis diagnosis was 10.9. There were a

total of 129 (6.7%) first fractures in patients with arthritis compared with

6,910 (3.3%) in controls over a median follow-up of 3.90 and 3.95 years,

respectively, in those with arthritis and controls.

The incidence rate ratios (95% confidence interval) for first

fracture among those with arthritis, compared with controls, according to

the age at the start of follow-up were 1.49 (0.91 to 2.31) for age less than

10 years; 3.13 (2.21 to 4.33) at 10-15 years; 1.75 (1.18 to 2.51) at 15-20

years; 1.40 (0.91 to 2.08) at 20-45 years; and 3.97 (2.23 to 6.59) at

greater than 45 years.

Previous research had established that patients with juvenile

idiopathic arthritis tend to have weaker bones, but the current study is the

first to document an increased fracture risk in a large cohort of these

patients as adults.

The results suggested that clinicians should be especially

vigilant in monitoring patients with a history of childhood-onset arthritis

for osteoporosis, Dr. Burnham and colleagues wrote.

The study found no significant associations between use of

arthritis drugs and fracture risk, including disease-modifying,

anti-rheumatic drugs (DMARDs), non-steroidal anti-inflammatory drugs

(NSAIDs), or glucocorticoids.

The study suggested that a patient with a history of childhood

arthritis and multiple fractures-or even a single severe fracture such as a

vertebral compression-should be evaluated for osteoporosis with a bone

mineral density scan, Dr. Burnham said.

However, such scans are challenging to perform and difficult to

interpret in pediatric patients, and diagnosing osteoporosis in this patient

group will likely require the help of an orthopedic surgeon or a pediatric

endocrinologist, he added.

Because children with arthritis are at risk for developing

suboptimal bone mass during the peak growth years of adolescence and early

adulthood, strategies to promote bone health should be promoted in this

group, including regular physical activity and adequate intake of calcium

and vitamin D, Dr. Burnham advised.

In the United States, juvenile-onset arthritis affects about one

in 1,000 children. Of these, 20% to 30% may develop osteoporosis, Dr.

Burnham said.

Primary source: ls of the Rheumatic Diseases

Source reference:

Jon Burnham et al. " Childhood onset arthritis is associated with

an increased risk of fracture: a population based study using the General

Practice Research Database. " ls of the Rheumatic Diseases 2006. Advanced

online publication April 21, 2006.

By Jeff Minerd, MedPage Today Staff Writer

Reviewed by Zalman S. Agus, MD; Emeritus Professor at the

University of Pennsylvania School of Medicine.

May 10, 2006