title: Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders.
abstract: OBJECTIVE
  Vertebral fractures are an under-recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy.
  
  
  METHODS
  Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x-ray absorptiometry for lumbar spine (L-spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L-spine BMD Z score, and back pain were analyzed for association with vertebral fracture.
  
  
  RESULTS
  Thirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2-3 fractures. Fractures were clustered in the mid-thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean +/- SD L-spine BMD Z score was significantly different from zero (-0.55 +/- 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 +/- 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1-53.8], P = 0.004).
  
  
  CONCLUSIONS
  In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Huber
authors.forename: I
authors.initials: I
authors.lastname: Gaboury
authors.forename: D A
authors.initials: DA
authors.lastname: Cabral
authors.forename: B
authors.initials: B
authors.lastname: Lang
authors.forename: A
authors.initials: A
authors.lastname: Ni
authors.forename: D
authors.initials: D
authors.lastname: Stephure
authors.forename: S
authors.initials: S
authors.lastname: Taback
authors.forename: P
authors.initials: P
authors.lastname: Dent
authors.forename: J
authors.initials: J
authors.lastname: Ellsworth
authors.forename: C
authors.initials: C
authors.lastname: LeBlanc
authors.forename: C
authors.initials: C
authors.lastname: Saint-Cyr
authors.forename: R
authors.initials: R
authors.lastname: Scuccimarri
authors.forename: J
authors.initials: J
authors.lastname: Hay
authors.forename: B
authors.initials: B
authors.lastname: Lentle
authors.forename: M
authors.initials: M
authors.lastname: Matzinger
authors.forename: N
authors.initials: N
authors.lastname: Shenouda
authors.forename: D
authors.initials: D
authors.lastname: Moher
authors.forename: F
authors.initials: F
authors.lastname: Rauch
authors.forename: K
authors.initials: K
authors.lastname: Siminoski
authors.forename: L M
authors.initials: LM
authors.lastname: Ward
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D016017:Odds Ratio; D012216:Rheumatic Diseases / Q000188:drug therapy*; D016103:Spinal Fractures / Q000139:chemically induced*; D013904:Thoracic Vertebrae / Q000293:injuries*
chemical_list: D005938:Glucocorticoids
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