Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders

Arthritis Care and Research - Tập 62 Số 4 - Trang 516-526 - 2010
Adam M. Huber1, Isabelle Gaboury2, David A. Cabral3, Bianca Lang1, Ai Ni4, David Stephure5, Shayne Taback6, Peter B. Dent7, Janet Ellsworth8, Claire LeBlanc8, Claire Saint‐Cyr9, Rosie Scuccimarri10, John Hay11, Brian C. Lentle3, Mary Ann Matzinger2, Nazih Shenouda2, David Moher2, Frank Rauch10, Kerry Siminoski8, Leanne M. Ward2
1Dalhousie University, Halifax, Nova Scotia, Canada.
2University of Ottawa, Ottawa, Ontario, Canada
3University of British Columbia, Vancouver, British Columbia, Canada
4Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
5University of Calgary, calgary, Alberta, canada
6University of Manitoba, Winnipeg, Manitoba, Canada
7McMaster University, Hamilton, Ontario, Canada
8University of Alberta, Edmonton, Alberta, Canada
9Université de Montréal, Montréal, Québec, Canada
10McGill University, Montreal, Quebec, Canada
11Brock University, St. Catharines, Ontario, Canada

Tóm tắt

AbstractObjectiveVertebral fractures are an under‐recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy.MethodsChildren were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12). Thoracolumbar spine radiograph and dual x‐ray absorptiometry for lumbar spine (L‐spine) areal bone mineral density (BMD) were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, L‐spine BMD Z score, and back pain were analyzed for association with vertebral fracture.ResultsThirteen vertebral fractures were noted in 9 children (7%). Of these, 6 patients had a single vertebral fracture and 3 had 2–3 fractures. Fractures were clustered in the mid‐thoracic region (69%). Three vertebral fractures (23%) were moderate (grade 2); the others were mild (grade 1). For the entire cohort, mean ± SD L‐spine BMD Z score was significantly different from zero (−0.55 ± 1.2, P < 0.001) despite a mean height Z score that was similar to the healthy average (0.02 ± 1.0, P = 0.825). Back pain was highly associated with increased odds for fracture (odds ratio 10.6 [95% confidence interval 2.1–53.8], P = 0.004).ConclusionIn pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.

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Tài liệu tham khảo

10.1002/art.20963

10.1007/BF01451301

10.4103/0256-4947.51458

10.1002/art.11097

10.1007/s00296-002-0265-0

10.1002/art.1780390506

Kotaniemi A, 1993, Estimation of central osteopenia in children with chronic polyarthritis treated with glucocorticoids, Pediatrics, 91, 1127, 10.1542/peds.91.6.1127

10.1080/03009749950155733

10.1007/BF03349860

Hartman C, 2004, Assessment of osteoporosis by quantitative ultrasound versus dual energy X‐ray absorptiometry in children with chronic rheumatic diseases, J Rheumatol, 31, 981

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

Pereira RM, 1998, Evaluation by dual X‐ray absorptiometry (DXA) of bone mineral density in children with juvenile chronic arthritis, Clin Exp Rheumatol, 16, 495

Brik R, 1998, Bone mineral density and turnover in children with systemic juvenile chronic arthritis, J Rheumatol, 25, 990

10.1002/1529-0131(200003)43:3<531::AID-ANR8>3.0.CO;2-X

10.1002/art.1780401108

10.1136/ard.54.3.193

10.1590/S0100-879X2005000200020

10.1002/art.22433

10.1002/art.11211

10.1080/03009740701687226

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/art.22691

10.1002/art.21115

10.1007/s002960050056

10.1177/0961203308089446

10.1590/S0100-879X2002001000008

10.1016/S1297-319X(02)00009-X

10.1136/ard.2005.048835

10.1016/j.jpeds.2008.09.023

10.1007/BF02555248

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

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, 229

10.1136/adc.44.235.291

10.1136/adc.45.239.13

10.1016/S0002-8223(21)02399-3

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

10.1002/ppul.20737

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

10.1359/jbmr.090202

10.1097/00000441-195909000-00030

10.1097/00004424-196801000-00005

1976 University of Ottawa Press Ottawa (Canada) SM Garn AK Poznanski K Larson ZF Jaworski Metacarpal lengths cortical diameters and areas from the 10‐state nutrition survey 367 91

Keats TE, 1977, An atlas of normal developmental anatomy

10.1002/jbmr.5650080915

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

Dennison E, 2000, Epidemiology of osteoporotic fractures, Horm Res, 54, 58, 10.1159/000063449

10.1359/jbmr.2000.15.3.564

10.1007/s00198-007-0381-5

10.1007/s001980050002

10.1007/s001980070066

10.1007/s001980050138

10.1038/sj.ijo.0801923

10.1359/jbmr.1999.14.5.821

10.1016/S8756-3282(03)00241-2

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Arthritis Care and Research

Tập 62 Số 4

516-526

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