The Journal of Clinical Endocrinology and Metabolism Journal Article

Bone Morbidity in Pediatric Rheumatic Disorders

December 14, 2021
 

Leanne M Ward, Jinhui Ma, Marie-Eve Robinson, Maya Scharke, Josephine Ho, Kristin Houghton, Adam Huber, Rosie Scuccimarri, Julie Barsalou, Johannes Roth, Nazih Shenouda, Mary Ann Matzinger, Brian Lentle, Jacob L Jaremko, Khaldoun Koujok, Karen Watanabe Duffy, Robert Stein, Anne Marie Sbrocchi, Celia Rodd, Paivi M Miettunen, Claire M A LeBlanc, Maggie Larche, Roman Jurencak, Elizabeth A Cummings, Robert Couch, David A Cabral, Stephanie Atkinson, Nathalie Alos, Elizabeth Sykes, Victor N Konji, Frank Rauch, Kerry Siminoski, Bianca Lang
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 12, December 2021, Pages e5195–e5207
https://doi.org/10.1210/clinem/dgab494

Abstract

Context

Osteoporotic fractures are an important cause of morbidity in children with glucocorticoid-treated rheumatic disorders.

Objective

This work aims to evaluate the incidence and predictors of osteoporotic fractures and potential for recovery over six years following glucocorticoid (GC) initiation in children with rheumatic disorders.

Methods

Children with GC-treated rheumatic disorders were evaluated through a prospective inception cohort study led by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium. Clinical outcomes included lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-VF, and vertebral body reshaping.

Results

A total of 136 children with GC-treated rheumatic disorders were enrolled (mean age 9.9 years, SD 4.4). The 6-year cumulative fracture incidence was 16.3% for VF, and 10.1% for non-VF. GC exposure was highest in the first 6 months, and 24 of 38 VF (63%) occurred in the first 2 years. Following VF, 16 of 19 children (84%) had complete vertebral body reshaping. Increases in disease activity and body mass index z scores in the first year and declines in LS BMD z scores in the first 6 months predicted incident VF over the 6 years, while higher average daily GC doses predicted both incident VF and non-VF. LS BMD z scores were lowest at 6 months (mean −0.9, SD 1.2) and remained low by 6 years even when adjusted for height z scores (−0.6, SD 0.9).

Conclusion

VF occurred early and were more common than non-VF in children with GC-treated rheumatic disorders. Eighty-four percent of children with VF underwent complete vertebral body reshaping, whereas vertebral deformity persisted in the remainder of children. On average, LS BMD z scores remained low at 6 years, consistent with incomplete recovery.

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