Osteoporotic Fractures and Vertebral Body Reshaping in Children with Glucocorticoid-treated Rheumatic Disorders

Authors

Leanne M. Ward, University of Ottawa
Jinhui Ma, McMaster University
Marie Eve Robinson, University of Ottawa
Maya Scharke, Children's Hospital of Eastern Ontario, Ottawa
Josephine Ho, University of Calgary
Kristin Houghton, The University of British Columbia
Adam Huber, Dalhousie University
Rosie Scuccimarri, Université McGill
Julie Barsalou, University of Montreal
Johannes Roth, University of Ottawa
Nazih Shenouda, University of Ottawa
Mary Ann Matzinger, University of Ottawa
Brian Lentle, The University of British Columbia
Jacob L. Jaremko, University of Alberta
Khaldoun Koujok, University of Ottawa
Karen Watanabe Duffy, University of Ottawa
Robert Stein, Western UniversityFollow
Anne Marie Sbrocchi, Université McGill
Celia Rodd, University of Manitoba
Paivi M. Miettunen, University of Calgary
Claire M.A. Leblanc, Université McGill
Maggie Larche, McMaster University
Roman Jurencak, University of Ottawa
Elizabeth A. Cummings, Dalhousie University
Robert Couch, University of Alberta
David A. Cabral, The University of British Columbia

Document Type

Article

Publication Date

12-1-2021

Journal

Journal of Clinical Endocrinology and Metabolism

Volume

106

Issue

12

First Page

E5195

Last Page

E5207

URL with Digital Object Identifier

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.