Dr. Siminoski has received consultancies, speaking fees, and/or honoraria (less than $10,000 each) from Amgen and Proctor & Gamble.
Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders†
Article first published online: 30 MAR 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 4, pages 516–526, April 2010
How to Cite
Huber, A. M., Gaboury, I., Cabral, D. A., Lang, B., Ni, A., Stephure, D., Taback, S., Dent, P., Ellsworth, J., LeBlanc, C., Saint-Cyr, C., Scuccimarri, R., Hay, J., Lentle, B., Matzinger, M., Shenouda, N., Moher, D., Rauch, F., Siminoski, K. and Ward, L. M. (2010), Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders. Arthritis Care Res, 62: 516–526. doi: 10.1002/acr.20171
Members of the Canadian STOPP Consortium are listed in Appendix A
- Issue published online: 30 MAR 2010
- Article first published online: 30 MAR 2010
- Manuscript Accepted: 30 NOV 2009
- Manuscript Received: 9 JUN 2009
- Canadian Institutes for Health Research
- Children's Hospital of Eastern Ontario
- Women and Children's Health Research Institute, University of Alberta
- Canadian Institutes for Health Research New Investigator Program and the Canadian Child Health Clinician Scientist Career Enhancement Program
Vertebral 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.
Children 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.
Thirteen 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).
In pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.