Pediatric rheumatology

Extremes in vitamin K status of bone are related to bone ultrasound properties in children with juvenile idiopathic arthritis

M.J.H. van Summeren¹, C. Vermeer², R.H.H. Engelbert³, L.J. Schurgers², T. Takken³, K. Fischer⁴, W. Kuis¹

1Department of Paediatric Immunology, 3Department of Paediatric Physical Therapy and Exercise Physiology, and 4Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht; 2Department of Biochemistry, University of Maastricht, The Netherlands.

ABSTRACT

Objective

Osteopenia is a common complication of juvenile idiopathic arthritis (JIA). In adults, low bone density and increased fracture risk are associated with low vitamin K status of bone. The vitamin K-dependent protein osteocalcin plays an important role in bone metabolism. Its activity depends upon post-translational carboxylation in which vitamin K is an essential co-factor. Hence, vitamin K deficiency leads to under-carboxylated (i.e., inactive) osteocalcin (ucOC). Little is known about the vitamin K status and bone health in children with juvenile idiopathic arthritis (JIA). We studied the vitamin K status of bone and its association with bone mass properties in children with JIA compared to healthy children.

Methods

We performed a cross sectional study in 55 children with JIA and 54 healthy controls between 6-18 years of age. Bone markers, ultrasound bone mass properties and vitamin K status of bone were determined.

Results

Overall, no differences in vitamin K status of bone were found between the study groups. Among children with JIA, a high ratio of ucOC/cOC indicating low vitamin K status was associated with low bone ultrasound parameters, whereas children with a high vitamin K status had markedly higher bone properties. This association was independent of physical activity, age, gender and BMI

Conclusion

These results suggest that vitamin K may be one of multiple risk factors for low bone mass in children with JIA, in addition to other recognized determinants of bone mass. The question remains whether JIA patients would benefit from increased dietary vitamin K intake.

Key words

Vitamin K, osteocalcin, arthritis, juvenile rheumatoid, bone density.

Please address correspondence and reprint requests to: Marieke J.H. van Summeren, Department of Paediatric Immunology, UMC UtrechtLundlaan 6, room KE.04.133.1, 3584 EA Utrecht, The Netherlands.

E-mail: m.j.h.vansummeren@umcutrecht.nl

Clin Exp Rheumatol 2008; 26: 484-491