title: Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program.
abstract: Vertebral compression is a serious complication of childhood acute lymphoblastic leukemia (ALL). The prevalence and pattern of vertebral fractures, as well as their relationship to BMD and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age, 5.3 yr; 108 boys) with ALL (precursor B cell: N = 167; T cell: N = 19) who were enrolled in a national bone health research program. Patients were assessed within 30 days of diagnosis by lateral thoraco-lumbar spine radiograph, bone age (also used for metacarpal morphometry), and BMD. Vertebral morphometry was carried out by the Genant semiquantitative method. Twenty-nine patients (16%) had a total of 75 grade 1 or higher prevalent vertebral compression fractures (53 thoracic, 71%; 22 lumbar). Grade 1 fractures as the worst grade were present in 14 children (48%), 9 patients (31%) had grade 2 fractures, and 6 children (21%) had grade 3 fractures. The distribution of spine fracture was bimodal, with most occurring in the midthoracic and thoraco-lumbar regions. Children with grade 1 or higher vertebral compression had reduced lumbar spine (LS) areal BMD Z-scores compared with those without (mean +/- SD, -2.1 +/- 1.5 versus -1.1 +/- 1.2; p < 0.001). LS BMD Z-score, second metacarpal percent cortical area Z-score, and back pain were associated with increased odds for fracture. For every 1 SD reduction in LS BMD Z-score, the odds for fracture increased by 80% (95% CI: 10-193%); the presence of back pain had an OR of 4.7 (95% CI: 1.5-14.5). These results show that vertebral compression is an under-recognized complication of newly diagnosed ALL. Whether the fractures will resolve through bone growth during or after leukemia chemotherapy remains to be determined.
authors.affiliation: University of Ottawa, Ontario, Canada.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Halton
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gaboury
authors.forename: Ronald
authors.initials: R
authors.lastname: Grant
authors.forename: Nathalie
authors.initials: N
authors.lastname: Alos
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cummings
authors.forename: Maryann
authors.initials: M
authors.lastname: Matzinger
authors.forename: Nazih
authors.initials: N
authors.lastname: Shenouda
authors.forename: Brian
authors.initials: B
authors.lastname: Lentle
authors.forename: Sharon
authors.initials: S
authors.lastname: Abish
authors.forename: Stephanie
authors.initials: S
authors.lastname: Atkinson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cairney
authors.forename: David
authors.initials: D
authors.lastname: Dix
authors.forename: Sara
authors.initials: S
authors.lastname: Israels
authors.forename: David
authors.initials: D
authors.lastname: Stephure
authors.forename: Beverly
authors.initials: B
authors.lastname: Wilson
authors.forename: John
authors.initials: J
authors.lastname: Hay
authors.forename: David
authors.initials: D
authors.lastname: Moher
authors.forename: Frank
authors.initials: F
authors.lastname: Rauch
authors.forename: Kerry
authors.initials: K
authors.lastname: Siminoski
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D016103:Spinal Fractures / Q000139:chemically induced / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000293:injuries*
chemical_list: D005938:Glucocorticoids