title: Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome.
abstract: CONCLUSIONS
  Eighty children with nephrotic syndrome underwent lumbar spine densitometry and vertebral morphometry soon after glucocorticoid initiation. We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%).
  
  
  BACKGROUND
  Vertebral fractures are an under-recognized complication of childhood glucocorticoid-treated illnesses. Our goal was to study the relationships among glucocorticoid exposure, lumbar spine areal BMD (LS BMD), and vertebral shape in glucocorticoid-treated children with new-onset nephrotic syndrome.
  
  
  METHODS
  Lateral thoracolumbar spine radiography and LS BMD were performed in 80 children with nephrotic syndrome (median age 4.4 years; 46 boys) within the first 37 days of glucocorticoid therapy. Genant semiquantitative grading was used as the primary method for vertebral morphometry; the algorithm-based qualitative (ABQ) method was used for secondary vertebral deformity analysis.
  
  
  RESULTS
  Six of the 78 children with usable radiographs (8%; 95% confidence interval 4 to 16%) manifested a single Genant grade 1 deformity each. All deformities were mild anterior wedging (two at each of T6, T7, and T8). Four of the 78 children (5%; 95% confidence interval 2 to 13%) showed one ABQ sign of fracture each (loss of endplate parallelism; two children at T6 and two at T8). Two of the children with ABQ signs also had a Genant grade 1 deformity in the same vertebral body. None of the children with a Genant or ABQ deformity reported back pain. An inverse relationship was identified between LS BMD Z-score and glucocorticoid exposure.
  
  
  CONCLUSIONS
  Although we identified an inverse relationship between steroid exposure and LS BMD soon after glucocorticoid initiation for childhood nephrotic syndrome, there was only a low rate of vertebral deformities. The clinical significance of these findings requires further study.
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Feber
authors.forename: I
authors.initials: I
authors.lastname: Gaboury
authors.forename: A
authors.initials: A
authors.lastname: Ni
authors.forename: N
authors.initials: N
authors.lastname: Alos
authors.forename: S
authors.initials: S
authors.lastname: Arora
authors.forename: L
authors.initials: L
authors.lastname: Bell
authors.forename: T
authors.initials: T
authors.lastname: Blydt-Hansen
authors.forename: C
authors.initials: C
authors.lastname: Clarson
authors.forename: G
authors.initials: G
authors.lastname: Filler
authors.forename: J
authors.initials: J
authors.lastname: Hay
authors.forename: D
authors.initials: D
authors.lastname: Hebert
authors.forename: B
authors.initials: B
authors.lastname: Lentle
authors.forename: M
authors.initials: M
authors.lastname: Matzinger
authors.forename: J
authors.initials: J
authors.lastname: Midgley
authors.forename: D
authors.initials: D
authors.lastname: Moher
authors.forename: M
authors.initials: M
authors.lastname: Pinsk
authors.forename: F
authors.initials: F
authors.lastname: Rauch
authors.forename: C
authors.initials: C
authors.lastname: Rodd
authors.forename: N
authors.initials: N
authors.lastname: Shenouda
authors.forename: K
authors.initials: K
authors.lastname: Siminoski
authors.forename: L M
authors.initials: LM
authors.lastname: Ward
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000293:Adolescent; D000886:Anthropometry / Q000379:methods; D001416:Back Pain / Q000139:chemically induced; D015519:Bone Density / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D013121:Spinal Curvatures / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016103:Spinal Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging
chemical_list: D005938:Glucocorticoids