Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: A national observational study Academic Article uri icon

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  • 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.


  • Rodd, Celia
  • Lang, Bianca
  • Ramsay, Timothy
  • Alos, Nathalie
  • Huber, Adam M
  • Cabral, David A
  • Scuccimarri, Rosie
  • Miettunen, Paivi M
  • Roth, Johannes
  • Atkinson, Stephanie
  • Couch, Robert
  • Cummings, Elizabeth A
  • Dent, Peter B
  • Ellsworth, Janet
  • Hay, John
  • Houghton, Kristin
  • Jurencak, Roman
  • Larche, Margaret
  • LeBlanc, Claire
  • Oen, Kiem
  • Saint-Cyr, Claire
  • Stein, Robert
  • Stephure, David
  • Taback, Shayne
  • Lentle, Brian
  • Matzinger, Maryann
  • Shenouda, Nazih
  • Moher, David
  • Rauch, Frank
  • Siminoski, Kerry
  • Ward, Leanne M

publication date

  • January 2012

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