Findings support the need for routine bone health screening in patients with AOSD and demonstrate a high burden of impaired bone health in patients with AOSD.
Abstract
Adult-onset Still’s disease (AOSD) is a chronic systemic inflammatory disorder with sustained elevation of pro-inflammatory cytokines and frequent glucocorticoid use. Real-world data on bone health in AOSD remain scarce. This study aimed to evaluate bone health parameters and their associations with inflammatory markers in patients with AOSD. This cross-sectional study included 54 patients with AOSD who underwent dual-energy x-ray absorptiometry (DXA) at a tertiary referral center. Bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, and trabecular bone score (TBS) were assessed. Associations between C-reactive protein (CRP), ferritin, cumulative glucocorticoid dose, and bone parameters were analyzed using Spearman correlation, partial correlation adjusted for age, sex, and body mass index (BMI), and multivariable logistic regression. The mean age was 58.2 ± 12.0 years (79.6% female). Osteoporosis and osteopenia were present in 40.7% and 38.9%, respectively. TBS assessment (n = 52) revealed that 38 patients (73.1%) had normal microarchitecture (TBS > 1.350) and 14 (26.9%) had partially degraded microarchitecture (TBS 1.200–1.350). CRP showed a significant negative correlation with TBS (r = −0.445, P = .001), which remained significant after Bonferroni correction (adjusted P = .019) and after partial correlation adjusting for age, sex, and BMI (r = −0.336, P = .015). In multivariable logistic regression adjusted for age, sex, and BMI, CRP was independently associated with osteoporosis (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01–1.27, P = .039). In patients aged ≥ 50 years, log-transformed ferritin was independently associated with osteoporosis (OR 4.34, 95% CI 1.43–13.13, P = .009). Cumulative glucocorticoid dose was not significantly associated with bone parameters. These real-world data demonstrate a high burden of impaired bone health in patients with AOSD. CRP was independently associated with TBS and osteoporosis after adjustment for age, sex, and BMI, and ferritin was associated with osteoporosis in patients aged ≥50 years. These findings support the need for routine bone health screening in AOSD.
The findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established, and that larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.
Anna Łupińska, Sara Aszkiełowicz, Arkadiusz Zygmunt et al.· Nutrients· 0 citations
Bone mineral density (BMD) is compromised in patients with systemic sclerosis (SSc) compared to the background population, yet the underlying disease related factors are less known. This study evaluates SSc disease-related features and predictability for BMD along with established risk factors for low BMD in SSc patients compared to controls. The study includes 211 SSc patients, 182 women and 29 men (mean age 61 yrs, mean disease duration 9 yrs) regularly followed at the Skåne University Hospital, Lund, Sweden and 505 age- and sex-matched controls. Data collection: BMD hip and spine, BMI, SSc-features, biomarkers and potential risk factor questionnaire. Multinomial logistic regression analysis was used to calculate BMD odds ratio (OR); multiple linear regression for associations between T-score and SSc-related variables and lifestyle factors; and machine learning to fit a model to predict total hip T-score in SSc. NT-proBNP and elevated CRP were independently associated with low BMD in SSc patients (p<0.001), as were diffuse cutaneous disease subtype, finger ulcers, vital lung capacity and anti-topoisomerase I antibodies (ATA). BMI, menopausal status, low physical activity and higher medication burden were associated with lower hip T-score. Predictive modeling identified BMI and NT-proBNP as the strongest determinants of hip T-score. This large case–control study finds elevated NT-proBNP, indicators of low-grade inflammation and of disease severity negatively associated with BMD in SSc patients, in addition to several established risk factors. This highlights the importance of BMD assessment to identify at-risk SSc patients beyond traditional risk stratification.
K. Lillpers, K. Andréasson, Seyed Morteza Najibi et al.· Arthritis Research & Therapy· 0 citations
Abstract Background and Objectives Patients with systemic lupus erythematosus (SLE) are at increased risk of osteoporosis due to chronic inflammation, prolonged glucocorticoid (GC) exposure, and treatment-related factors. Hydroxychloroquine (HCQ), a cornerstone of SLE therapy, has shown conflicting effects on bone health. This study examined the association between HCQ use and bone mineral density (BMD) in SLE. Methods A cross-sectional study of 213 SLE patients was conducted at Dr. Soetomo General Academic Hospital. BMD was assessed by dual-energy X-ray absorptiometry (DXA) and classified using WHO criteria. Demographic, clinical, laboratory, and treatment-related variables were collected. Group comparisons employed chi-square and non-parametric tests, while ordinal logistic regression identified independent predictors of reduced BMD. Methods Among 213 patients, 22.5% had normal BMD, 51.2% osteopenia, and 26.3% osteoporosis. Independent predictors of reduced BMD were older age (OR 1.05, 95% CI 1.01–1.09), higher cumulative GC exposure (OR 1.07, 95% CI 1.02–1.12), and lower BMI (OR 0.89, 95% CI 0.80–0.98). Importantly, the use of HCQ has been linked to a protective effect against osteoporosis (OR 0.47, 95% CI 0.22–0.97, P = 0.040). Neither SLEDAI scores nor complement/ESR levels were significantly associated with BMD. Conclusion Low BMD is highly prevalent in SLE and is strongly influenced by age, GC exposure, and BMI. HCQ use was linked to a protective effect on bone health, plausibly mediated by anti-resorptive, antioxidant, and glucocorticoid-sparing properties. Although a causal relationship between these two variables cannot yet be established, this association underscores the need for further well-designed longitudinal or interventional studies.
Awalia, S. G. Kandinata, Arinditia Triasti Putri et al.· Rheumatology and Immunology...· 0 citations
Objectives
Type 1 diabetes (T1D) is a recognized risk factor for skeletal fragility in adults, but its impact on bone microstructure in children remains incompletely characterized. In particular, data on trabecular bone quality remain scarce. This study aimed to evaluate skeletal parameters in this group of children and examine their associations with clinical variables.
Methods
This retrospective cross-sectional study evaluated children with T1D at the Hong Kong Children's Hospital from June 2023 to December 2024. Skeletal parameters, including trabecular bone score (TBS), bone health index (BHI), bone mineral density (BMD) by dual-energy x-ray absorptiometry, and serum vitamin D and HbA1c levels, were evaluated alongside fracture history. A parent-reported questionnaire measured participation in physical activity. Correlations between bone parameters and clinical variables were analyzed.
Results
Sixty-eight children with T1D (male 42.6%, mean 12.7 ± 3.7 years, 44.1% prepubertal, mean HbA1c 7.3%) were included. A substantial proportion of children (19.6%) had low cortical bone density as reflected by BHI Z-score ≤ -2, whereas deficits in trabecular bone (TBS Z-score ≤ -2) were less common (4.8 %). Regression analysis confirmed that higher lean mass was associated with higher total body less head (TBLH), lumbar spine (LS) and TBS Z-scores (β=0.0001, p < 0.05), while disease duration had a negative association with these measurements (β=-0.1413; β =-0.1335, β=-0.2270, p < 0.05).
Conclusion
In this cohort of children with T1D, a pattern of skeletal involvement was observed, characterized by a high prevalence of low BHI Z-scores and a relatively low prevalence of low TBS Z-scores. This may suggest differential involvement of cortical bone with relative preservation of trabecular microarchitecture. Whether these structural differences translate into fracture risk remains unknown. Longitudinal studies are needed to elucidate the evolution of bone alterations over time and to identify determinants underlying skeletal vulnerability in childhood-onset diabetes. Higher lean mass was associated with higher bone mass and microarchitectural indices, whereas longer disease duration may have a negative association with these parameters. These findings highlight modifiable and disease-related factors that may influence bone health, warranting confirmation in larger controlled studies.
S. W. Poon, Jian-Fang Zhu, Gloria S. W. Pang et al.· Journal of Clinical Research...· 0 citations
Assessment of bone mineral density (BMD), trabecular bone score (TBS), and muscle mass in adults with PIDs found reduced BMD and impaired TBS represented distinct, partially overlapping findings.
A. Nowakowska-Płaza, J. Wroński, A. Zegadło et al.· Frontiers in Endocrinology· 0 citations
No routinely measured biomarker demonstrated clinical utility for identifying BMD trajectory in this cohort of Saudi dual-energy X-ray absorptiometry patients, suggesting future studies with explicit treatment tracking and repeated bone-turnover measurements are required for confirmation.
L. Jambi, S. Kabrah· Journal of Clinical Medicine· 0 citations
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