Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: a national observational study.
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Rodd Celia, Lang Bianca, Ramsay Timothy, Alos Nathalie, Huber Adam M, Cabral David A, Scuccimarri Rosie, Miettunen Paivi M, Roth Johannes, Atkinson Stephanie A, Couch Robert, Cummings Elizabeth A, Dent Peter B, Ellsworth Janet, Hay John, Houghton Kristin, Jurencak Roman, Larché Maggie, LeBlanc Claire, Oen Kiem, Saint-Cyr Claire, Stein Robert, Stephure David, Taback Shayne, Lentle Brian, Matzinger Maryann, Shenouda Nazih, Moher David, Rauch Frank, Siminoski Kerry, Ward Leanne M, Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium
Аннотация
METHODS: Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z scores, were analyzed for association with IVF.
RESULTS: Seven (6%) of 118 children (95% confidence interval 2.9-11.7%) had IVF. Their diagnoses were: juvenile dermatomyositis (n = 2), systemic lupus erythematosus (n = 3), systemic vasculitis (n = 1), and mixed connective tissue disease (n = 1). One child was omitted from the analyses after 4 months because of osteoporosis treatment for symptomatic IVF. Children with IVF received on average 50% more GC than those without (P = 0.030), had a greater increase in body mass index (BMI) at 6 months (P = 0.010), and had greater decrements in spine aBMD Z scores in the first 6 months (P = 0.048). Four (67%) of 6 children with IVF and data to 12 months had spine aBMD Z scores less than -2.0 at 12 months compared to 16% of children without IVF (P = 0.011).
CONCLUSION: The incidence of VF 12 months following GC initiation was 6%; most children were asymptomatic. Children with IVF received more GC, had greater increases in BMI, and had greater declines in spine aBMD Z scores in the first 6 months.