John Hopkins University has licensed the HSA software to Hologic, Inc. Dr Beck has received research funding and speakers fees from Merck, Eli Lilly, Amgen, and NPS Pharmaceuticals. All other authors state that they have no conflicts of interest.
Alterations in Proximal Femur Geometry in Children Treated with Glucocorticoids for Crohn Disease or Nephrotic Syndrome: Impact of the Underlying Disease†
Article first published online: 22 JAN 2007
Copyright © 2007 ASBMR
Journal of Bone and Mineral Research
Volume 22, Issue 4, pages 551–559, April 2007
How to Cite
Burnham, J. M., Shults, J., Petit, M. A., Semeao, E., Beck, T. J., Zemel, B. S. and Leonard, M. B. (2007), Alterations in Proximal Femur Geometry in Children Treated with Glucocorticoids for Crohn Disease or Nephrotic Syndrome: Impact of the Underlying Disease. J Bone Miner Res, 22: 551–559. doi: 10.1359/jbmr.070110
- Issue published online: 4 DEC 2009
- Article first published online: 22 JAN 2007
- Manuscript Accepted: 19 JAN 2007
- Manuscript Revised: 15 NOV 2006
- Manuscript Received: 8 AUG 2006
- Crohn disease;
- nephrotic syndrome;
- proximal femur;
Proximal femur geometry was assessed in children and young adults treated with chronic GCs for CD or SSNS. Subperiosteal width and section modulus were significantly lower in CD and greater in SSNS compared with controls, highlighting the importance of the underlying disease, persistent inflammation, and alterations in lean mass.
Introduction: The impact of glucocorticoid (GC) therapy on bone structure during growth is unknown. Our objective was to characterize proximal femur geometry in children and young adults with Crohn disease (CD) or steroid-sensitive nephrotic syndrome (SSNS) compared with controls and to evaluate the influence of lean mass and GC therapy on bone parameters.
Materials and Methods: DXA scans of the hip and whole body were obtained in 88 subjects with CD, 65 subjects with SSNS, and 128 controls (4–26 years of age). Hip structural analysis parameters (subperiosteal width, cross-sectional area [CSA], and section modulus in the narrow neck [NN], intertrochanteric region [IT], and femoral shaft [FS]), areal BMD, and whole body lean mass were expressed as Z scores compared with controls. Multivariable linear regression was used to adjust outcomes for group differences in age, sex, race, and height.
Results: Mean lean mass Z scores were lower in CD (−0.63, p < 0.001) and greater in SSNS (0.36, p = 0.03) compared with controls. Hip areal BMD Z scores were lower in CD (−0.73, p < 0.001) but not SSNS (−0.02, p > 0.2) compared with controls. In CD, Z scores for subperiosteal width (NN: −1.66, p < 0.001; FS: −0.86, p < 0.001) and section modulus (NN: −0.60, p = 0.003; FS: –0.36, p = 0.03) were significantly lower than controls. In contrast, in SSNS, Z scores were greater for IT subperiosteal width (0.39, p = 0.02), FS CSA (0.47, p = 0.005), and FS section modulus (0.49, p = 0.004). Alterations in section modulus in CD and SSNS were eliminated after adjustment for lean mass. Cumulative GC dose was inversely associated with FS subperiosteal width and section modulus only in CD.
Conclusions: These data show that the effects of GC on proximal femur geometry during growth are influenced by the underlying disease, persistent inflammation, and alterations in lean mass. These data also provide insight into the structural basis of hip fragility in CD.