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

2011; Wiley; Volume: 64; Issue: 1 Linguagem: Inglês

10.1002/acr.20589

2151-4658

Celia Rodd, Bianca Lang, Tim Ramsay, Nathalie Alos, Adam M. Huber, David A. Cabral, Rosie Scuccimarri, Päivi Miettunen, Johannes Roth, Stephanie A. Atkinson, Robert Couch, Elizabeth A. Cummings, Peter B. Dent, Janet Ellsworth, John Hay, Kristin Houghton, Roman Juřenčák, Maggie Larché, Claire LeBlanc, Kiem Oen, Claire Saint‐Cyr, Robert Stein, David Stephure, Shayne Taback, Brian C. Lentle, Mary‐Ann Matzinger, Nazih Shenouda, David Moher, Frank Rauch, Kerry Siminoski, Leanne M. Ward,

Systemic Lupus Erythematosus Research

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.