Drs. Rodd and Lang contributed equally to this work.
Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study
Article first published online: 28 DEC 2011
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 1, pages 122–131, January 2012
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
- Issue published online: 28 DEC 2011
- Article first published online: 28 DEC 2011
- Accepted manuscript online: 30 AUG 2011 10:14AM EST
- Manuscript Accepted: 1 AUG 2011
- Manuscript Received: 1 APR 2011
- 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
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.
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.
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).
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.