Session Information
Date: Sunday, November 13, 2016
Title: Osteoporosis and Metabolic Bone Disease – Clinical Aspects and Pathogenesis - Poster
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of chronic inflammatory arthritides. JIA is the most common cause of musculoskeletal disability in children, and greater than 1/3 of children with JIA have persistent disease into adulthood. JIA is associated with decreased bone mineral density, growth abnormalities and erosive joint damage. We aimed to determine the prevalence of clinical osteoporosis and related outcome measures in adults with a history of JIA at Penn State Hershey Medical Center.
Methods: We performed a retrospective analysis of 67 adult patients with a history of JIA, age of onset ≤ 16 years, treated at Penn State Hershey from January 1st 2013-June 1st, 2015. After medical record extraction with review by two physicians, covariates focusing on JIA and osteoporosis risk factors were recorded in a REDCap database. Clinical osteoporosis was defined as a clinical diagnosis of osteoporosis by the physician and/or fragility fracture. Standard descriptive statistics were used to calculate means, standard deviations and frequencies. Covariates were compared between subjects with and without clinical osteoporosis using nonparametric tests. Statistical significance was determined by P values of <= 0.05.
Results: Patients had a mean age of 26 years, disease duration of 19 (+/- 9.5) years and were 85% female with 67.2% having polyarticular disease. Twelve percent (8/67) had clinical osteoporosis. Clinical osteoporosis was associated with longstanding disease features including disease duration and current age (p=0.05), increased disability scores on the health assessment questionnaire (p=0.035), history of orthopedic and joint replacement surgery (p < 0.0001 for both), increased frequency of current glucocorticoid use (p=0.0052), erosive joint disease (p=0.01) and there was a trend for association with ETOH use (p=0.07). More clinical osteoporosis subjects were using calcium and vitamin D (p=0.0052), had DEXA scans ordered (p < 0.0001) and vitamin D levels within the past year. No significant difference was observed for JIA classification subtype, gender, BMI, tobacco use, current or history of methotrexate or Tumor Necrosis Factor α-inhibitor use.
Conclusion: Adult patients with a history of JIA have a high prevalence of clinical osteoporosis, which is associated with both long standing JIA and glucocorticoid use. Adult Rheumatology providers should have increased awareness of poor osteoporotic outcomes in this unique patient population. Table: Univariate Analysis of Osteoporotic vs Non-Osteoporotic subjects with a History of JIA
| Item | Overall Mean±SD (N)/%(Ratio) | Osteoporosis Mean±SD (N)/%(Ratio) | No osteoporosis Mean±SD (N)/%(Ratio) | p-value |
| Demographics and JIA Disease Features | ||||
| Age | 26.09 ± 8.177 (67) | 38.76 ± 26.49 (8) | 22.75 ±7.34 (59) | 0.0454* |
| Age at diagnosis | 7.03 ± 4.90 (66) | 5.47 ± 3.62 (8) | 5.68 ± 8.53 (58) | 0.9922 |
| Disease Duration | 18.99 ± 9.48 (66) | 31.10 ± 27.08 (8) | 18.28 ± 10.90 (58) | 0.0483* |
| BMI | 28.88 ± 9.11 (67) | 23.09 ± 5.44 (8) | 27.49 ± 10.57 (59) | 0.1593 |
| Gender (% Female) | 85% (57/67) | 75% (6/8) | 86.4% (51/59) | 0.3413 |
| Current tobacco use | 7.6% (5/66) | 12.50% (1/8) | 6.90% (4/58) | 0.4873 |
| Current ETOH use | 43.3% (26/60) | 75.00% (6/8) | 38.46% (20/52) | 0.0669 |
| HAQ | 0.3966 ± 0.55 (58/67) | 0.6875 ± 1.0625 (8) | 0.0625 ± 0.6250 (50) | 0.0351* |
| RF positive (%) | 24.4% (10/41) | 40.00% (2/5) | 22.22% (8/36) | 0.5801 |
| Current Glucocorticoid Use | 11.9% (8/67) | 50.0% (4/8) | 6.8% (4/59) | 0.0052* |
| Bone Outcomes | ||||
| Osteopenia on X rays | 50.9% (27/53) | 100.00% (7/7) | 43.48% (20/46 ) | 0.0100* |
| Erosions on X rays | 50.9% (27/53) | 100.00% (7/7) | 43.48% (20/46) | 0.0100* |
| Erosions and Osteopenia X-rays | 34.0% (18/53) | 100.00% (7/7) | 23.91% (11/46) | 0.0002* |
| Any Orthopedic Surgery | 32.8% (22/67) | 100.00% (8/8) | 23.73% (14/59) | <0.0001* |
| Joint Replacement Surgery | 13.4% (9/67) | 75.00% (6/8) | 5.08% (3/59) | <0.0001* |
| Fractures (excluding fragility) | 20.9% (14/67) | 50.00% (4/8) | 16.95% (10/59) | 0.0528 |
To cite this abstract in AMA style:
Dodanwala H, Feger D, Longson N, Olsen NJ, Ostrov BE, June RR. High Risk of Osteoporosis and Long Term Joint Damage in Adults with a History of Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/high-risk-of-osteoporosis-and-long-term-joint-damage-in-adults-with-a-history-of-juvenile-idiopathic-arthritis/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-risk-of-osteoporosis-and-long-term-joint-damage-in-adults-with-a-history-of-juvenile-idiopathic-arthritis/