Bone mineral metabolism and body composition in juvenile dermatomyositis / Avaliação do metabolismo óssea e composição corporal em pacientes com dermatomiosite juvenil

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Objective. To analyze bone mineral density (BMD) in Juvenile Dermatomyositis (JDM) and its possible association with body composition, disease activity, duration of disease, glucocorticoid (GC) use and biochemical bone parameters (including osteoprotegerin and RANKL). Methods. Twenty girls with JDM and 20 controls gender- and age-matched were selected for the study. BMD was analyzed by dual energy X-ray absorptiometry (DXA) and bone mineral apparent density (BMAD) was calculated. Body composition (lean and fat mass) was also analyzed using DXA. Duration of disease, mean daily and cumulative steroid doses were calculated on the basis of their medical charts. Disease activity and muscle strength were measured by Disease Activity Score (DAS), Childhood Myositis Assessment Scale (CMAS), and Manual Muscle Testing (MMT). Inflammatory and bone metabolism parameters were also analyzed. Osteoprotegerin (OPG) and RANKL were measured in patients and controls, using ELISA. Results. A lower BMAD in femoral neck (0.302 ± 0.059 vs. 0.373 ± 0.049 g/cm3, P <0.001), total femur (0.128 ± 0.022 vs. 0.155 ± 0.019 g/cm3, P <0.001) and whole body without head (0.657 ± 0.135 vs. 0.776 ± 0.120 g/cm3, P = 0.005) was observed in JDM compared to controls. Interestingly, body composition showed a lower lean mass in JDM when compared to controls (24.04 ± 7.38 vs. 30.08 ± 7.66 kg, P = 0.015), but no difference was observed related to fat mass (16.13 ± 7.19 vs. 14.82 ± 7.17 kg, P = 0.565). A trend of lower serum calcium was observed in JDM compared to controls (9.60 ± 0.27 vs. 9.80 ± 0.43 mg/dl, P = 0.050), whereas all other parameters analyzed, including OPG and RANKL, were similar (P >0.05). Multiple linear regression analysis revealed that, in JDM, lean mass and GC pulse therapy use were independent factors for BMAD in femoral neck and total femur (P <0.05). Conclusion. The present study identifies that low lean mass and GC pulse therapy are the major factors for low femur BMAD in JDM patients emphasizing the need for better muscular therapeutic approach and spare GC pulse therapy use in order to prevent hip bone loss.

ASSUNTO(S)

criança dermatomyositis osso/metabolismo adolescente bone/metabolism children composição corporal body composition bone density adolescent dermatomiosite densidade óssea

ACESSO AO ARTIGO

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