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Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study

  1. Celia Rodd1,†,
  2. Bianca Lang2,†,
  3. Timothy Ramsay3,
  4. Nathalie Alos4,
  5. Adam M. Huber2,
  6. David A. Cabral5,
  7. Rosie Scuccimarri1,
  8. Paivi M. Miettunen6,
  9. Johannes Roth3,
  10. Stephanie A. Atkinson7,
  11. Robert Couch8,
  12. Elizabeth A. Cummings2,
  13. Peter B. Dent7,
  14. Janet Ellsworth8,
  15. John Hay9,
  16. Kristin Houghton5,
  17. Roman Jurencak3,
  18. Maggie Larché7,
  19. Claire LeBlanc8,
  20. Kiem Oen10,
  21. Claire Saint-Cyr4,
  22. Robert Stein11,
  23. David Stephure6,
  24. Shayne Taback10,
  25. Brian Lentle5,
  26. Maryann Matzinger3,
  27. Nazih Shenouda3,
  28. David Moher3,
  29. Frank Rauch1,
  30. Kerry Siminoski8,
  31. Leanne M. Ward3,*,
  32. Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium‡

Article first published online: 28 DEC 2011

DOI: 10.1002/acr.20589

Issue

Arthritis Care & Research

Arthritis Care & Research

Volume 64, Issue 1, pages 122–131, January 2012

Additional Information

How to Cite

Rodd, C., Lang, B., Ramsay, T., Alos, N., Huber, A. M., Cabral, D. A., Scuccimarri, R., Miettunen, P. M., Roth, J., Atkinson, S. A., Couch, R., Cummings, E. A., Dent, P. B., Ellsworth, J., Hay, J., Houghton, K., Jurencak, R., Larché, M., LeBlanc, C., Oen, K., Saint-Cyr, C., Stein, R., Stephure, D., Taback, S., Lentle, B., Matzinger, M., Shenouda, N., Moher, D., Rauch, F., Siminoski, K., Ward, L. M. and Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium (2012), Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study. Arthritis Care Res, 64: 122–131. doi: 10.1002/acr.20589

Author Information

  1. 1

    McGill University, Montreal, Quebec, Canada

  2. 2

    Dalhousie University, Halifax, Nova Scotia, Canada

  3. 3

    University of Ottawa, Ottawa, Ontario, Canada

  4. 4

    University of Montreal, Montreal, Quebec, Canada

  5. 5

    University of British Columbia, Vancouver, British Columbia, Canada

  6. 6

    University of Calgary, Calgary, Alberta, Canada

  7. 7

    McMaster University, Hamilton, Ontario, Canada

  8. 8

    University of Alberta, Edmonton, Alberta, Canada

  9. 9

    Brock University, St. Catharines, Ontario, Canada

  10. 10

    University of Manitoba, Winnipeg, Manitoba, Canada

  11. 11

    University of Western Ontario, London, Ontario, Canada

  1. †

    Drs. Rodd and Lang contributed equally to this work.

  2. ‡

    Members of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium are shown in Appendix A.

*401 Smyth Road, Ottawa, Ontario, Canada K1H 8L1

  1. †

    Drs. Rodd and Lang contributed equally to this work.

  2. ‡

    Members of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Consortium are shown in Appendix A.

Publication History

  1. Issue published online: 28 DEC 2011
  2. Article first published online: 28 DEC 2011
  3. Accepted manuscript online: 30 AUG 2011 10:14AM EST
  4. Manuscript Accepted: 1 AUG 2011
  5. Manuscript Received: 1 APR 2011

Funded by

  • Canadian Institutes of Health Research
  • Children's Hospital of Eastern Ontario Research Institute, University of Ottawa
  • Women and Children's Health Research Institute, University of Alberta
  • Canadian Child Health Clinician Scientist Career Enhancement Program
  • Canadian Institutes of Health Research New Investigator Program

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Abstract

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).

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.

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