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

Arthritis Care and Research - Tập 64 Số 1 - Trang 122-131 - 2012
Celia Rodd1, Bianca Lang2, Tim Ramsay3, Nathalie Alos4, Adam M. Huber2, David A. Cabral5, Rosie Scuccimarri1, Päivi Miettunen6, Johannes Roth3, Stephanie A. Atkinson7, Robert Couch8, Elizabeth Cummings2, Peter B. Dent7, Janet Ellsworth8, John Hay9, Kristin Houghton5, Roman Juřenčák3, Maggie Larché7, Claire LeBlanc8, Kiem Oen10, Claire Saint‐Cyr4, Robert Stein11, David Stephure6, Shayne Taback10, Brian C. Lentle5, Mary Ann Matzinger3, Nazih Shenouda3, David Moher3, Frank Rauch1, Kerry Siminoski8, Leanne M. Ward3
1McGill University, Montreal, Quebec, Canada
2Dalhousie University, Halifax, Nova Scotia, Canada.
3University of Ottawa, Ottawa, Ontario, Canada
4University of Montreal, Montreal, Quebec, Canada
5University of British Columbia, Vancouver, British Columbia, Canada
6University of Calgary, calgary, Alberta, canada
7McMaster University, Hamilton, Ontario, Canada
8University of Alberta, Edmonton, Alberta, Canada
9Brock University, St. Catharines, Ontario, Canada
10University of Manitoba, Winnipeg, Manitoba, Canada
11University of Western Ontario London, Ontario, Canada

Tóm tắt

AbstractObjectiveTo 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.MethodsChildren 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.ResultsSeven (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).ConclusionThe 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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Tài liệu tham khảo

Alsufyani KA, 2005, Bone mineral density in children and adolescents with systemic lupus erythematosus, juvenile dermatomyositis, and systemic vasculitis: relationship to disease duration, cumulative corticosteroid dose, calcium intake, and exercise, J Rheumatol, 32, 729

10.1002/acr.20171

10.3899/jrheum.091241

10.1002/1529-0131(200007)43:7<1504::AID-ANR13>3.0.CO;2-0

10.1002/art.11097

10.1016/j.jpeds.2004.10.052

10.1007/s002960050056

10.1016/j.jpeds.2008.09.023

10.1007/BF02555248

10.1177/0961203308089446

Reyes ML, 2007, Corticosteroid‐induced osteoporosis in children: outcome after two‐year follow‐up, risk factors, densitometric predictive cut‐off values for vertebral fractures, Clin Exp Rheumatol, 25, 329

Valta H, 2007, Bone health and growth in glucocorticoid‐treated patients with juvenile idiopathic arthritis, J Rheumatol, 34, 831

Institute of Medicine, 1997, Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, fluoride

10.3390/nu2080805

10.1542/peds.109.1.45

World Health Organization Multicentre Growth Reference Study Group, 2006, WHO child growth standards: length/height‐for‐age, weight‐for‐age, weight‐for‐length, weight‐for‐height and body mass index‐for‐age: methods and development

Hay J, 1997, Development and validation of the Habitual Activity Estimation Scale (HAES), Children Exerc, 19, 125

10.1093/rheumatology/keh284

Falcone A, 2005, Inter‐observer agreement of the physician's global assessment of disease activity in children with juvenile idiopathic arthritis, Clin Exp Rheumatol, 23, 113

10.1002/art.1780401109

10.1002/art.21984

10.1053/j.gastro.2008.09.072

10.1007/s001980200108

10.1002/jbmr.5650080915

10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E

10.1385/JCD:7:1:51

10.1136/ard.2005.048835

10.1016/j.jocd.2009.09.005

10.1001/jama.285.3.320

10.1007/s001980050138

10.1001/jama.298.23.2761

10.1002/art.20963

10.1002/1529-0131(200112)44:12<2790::AID-ART466>3.0.CO;2-X

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Arthritis Care and Research

Tập 64 Số 1

122-131

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