Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: a national observational study.
OBJECTIVE
To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk.


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).


CONCLUSIONS
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.
McGill University, Montreal, Quebec, Canada.
Celia
C
Rodd
Bianca
B
Lang
Timothy
T
Ramsay
Nathalie
N
Alos
Adam M
AM
Huber
David A
DA
Cabral
Rosie
R
Scuccimarri
Paivi M
PM
Miettunen
Johannes
J
Roth
Stephanie A
SA
Atkinson
Robert
R
Couch
Elizabeth A
EA
Cummings
Peter B
PB
Dent
Janet
J
Ellsworth
John
J
Hay
Kristin
K
Houghton
Roman
R
Jurencak
Maggie
M
Larché
Claire
C
LeBlanc
Kiem
K
Oen
Claire
C
Saint-Cyr
Robert
R
Stein
David
D
Stephure
Shayne
S
Taback
Brian
B
Lentle
Maryann
M
Matzinger
Nazih
N
Shenouda
David
D
Moher
Frank
F
Rauch
Kerry
K
Siminoski
Leanne M
LM
Ward
D015502:Absorptiometry, Photon; D000293:Adolescent; D001416:Back Pain / Q000139:chemically induced / Q000453:epidemiology; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects*; D008297:Male; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids