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Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study
Authors
Nathalie Alos
Stephanie A. Atkinson
+29 more
David A. Cabral
Robert Couch
Elizabeth A. Cummings
Peter B. Dent
Janet Ellsworth
John Hay
Kristin Houghton
Adam M. Huber
Roman Jurencak
Bianca Lang
Maggie Larché
Claire LeBlanc
Brian Lentle
MaryAnn Matzinger
Paivi M. Miettunen
David Moher
Kiem Oen
Timothy Ramsay
Frank Rauch
Celia Rodd
Johannes Roth
Claire Saint-Cyr
Rosie Scuccimarri
Nazih Shenouda
Kerry Siminoski
Robert Stein
David Stephure
Shayne Taback
Leanne M. Ward
Publication date
1 January 2012
Publisher
Scholarship@Western
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Abstract
Objective. 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. Methods. 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. Results. 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). Conclusion. 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. © 2012, American College of Rheumatology
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Last time updated on 08/10/2022