Bone health in juvenile idiopathic arthritis compared with controls based on a Norwegian observational study

Abstract

Background: Children with juvenile idiopathic arthritis (JIA) are at risk for impaired bone health. This study evaluates bone mineral density (BMD) and potential risk factors for reduced BMD.

Methods: In the NorJIA study, Norwegian children with JIA, and age-matched and sex-matched controls participated in a multicentre cohort study with clinical examinations, questionnaires, imaging and blood tests. BMD was measured using dual-energy X-ray absorptiometry and adjusted for bone age. Standard descriptive statistics and t-tests were used.

Results: 205 children with JIA had BMD measured at two study visits, 2 years apart and 125 controls at the second visit. At visit 2, median age was 14.7 years (IQR 11.5-16.6). Median disease duration was 6.6 (IQR 4.7-10.4) years, 50.7% had used or were currently using biologic disease-modifying antirheumatic drugs and 25.9% had ever used systemic steroids. There were no substantial differences in BMD Z-scores between the JIA group and controls. Mean BMD Z-score L1-L4 in JIA was 0.0 (95% CI -0.1, 0.1) and in controls 0.1 (95% CI -0.1, 0.3). A robust association was seen between physical activity levels and BMD. In children with JIA, the mean BMD Z-score L1-L4 was -0.3 (95% CI -0.6, 0.0) in the low-activity group and 0.2 (95% CI 0.0, 0.4) in the high-activity group, with a similar trend in controls. Children with JIA were as physically active as controls.

Conclusions: BMD Z-scores in JIA were similar to controls and positively associated with physical activity. This underlines the importance of early disease control, steroid-sparing medications and physical activity to optimise bone health.

Trial registration number: NCT03904459.

Keywords: Arthritis, Juvenile; Bone Density; Child.

Figure 1. Flow chart of participating children and adolescents with juvenile idiopathic arthritis (JIA) and controls. (BA automatically measured by the software program BoneXpert, which assesses skeletal age from 21 bones in a digitalised radiograph of the left hand). BA-adj., bone age-adjusted; DXA, dual-energy X-ray absorptiometry; L1-L4, lumbar spine from L1 to L4; V1, visit 1; V2, visit 2.

Figure 2. Distribution of lumbar L1-L4 bone age adjusted (BA-adj) bone mineral density (BMD) Z-scores in children with juvenile idiopathic arthritis (JIA) (left) compared with controls (right) at study visit 2. The x-axis of the histogram represents Z-scores, and the y-axis shows the percentage of individuals within each Z-score range. BA was automatically measured by the software program BoneXpert, which assesses skeletal age from 21 bones in a digitalised radiograph of the left hand and used for adjustments of BMD Z-scores.