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PHILADELPHIA — Vertebral fractures are present in a significant percentage of children with rheumatic diseases, and these fractures appear prior to prolonged glucocorticoid exposure, according to Dr. Leanne M. Ward.
“Vertebral fractures are an underrecognized complication of steroid-treated rheumatic disorders,” said Dr. Ward, director of the Pediatric Bone Health Clinical and Research Programs at University of Ottawa. “But when do the fractures first occur—in the course of the disease or steroid treatment.”
Investigators from the Canadian STOPP (Steroid-Associated Osteoporosis in the Pediatric Population) Consortium evaluated the spine health of 134 children (89 girls, median age 10 years) with rheumatic conditions. Thirty children had juvenile dermatomyositis (JDM), 28 had juvenile idiopathic arthritis (JIA) excluding systemic JIA, and 76 were diagnosed with other rheumatic disorders (systemic lupus erythematosus, systemic vasculitides, systemic JIA, and others). The children underwent thoracolumbar spine x-rays and lumbar spine areal bone mineral density (LS aBMD) evaluation within 30 days of beginning glucocorticoid therapy.
Seven percent of the group (9 of 134) had vertebral fractures; in these 9 children, 6 patients had a single vertebral fracture, while 3 patients had between 2 and 5 fractures, for a total of 13 fractures. Three of the fractures (23%) were moderate, and the rest were deemed mild. Most fractures were located in the mid-thoracic and upper lumbar regions, said Dr. Ward, who presented the findings at the annual meeting of the American College of Rheumatology.
Although the mean LS aBMD scores for the group were lower compared with the norm (−0.6 plus or minus 1.22, P<.001), LS aBMD did not predict the development of vertebral fractures. The odds for fracture were increased 10-fold if the child reported back pain.
The STOPP Consortium was founded in 2003 as a Canadian national pediatric bone health working group of investigators from 12 tertiary children's hospitals. Its main focus is to track bone mineral accrual and incident spine fractures in glucocorticoid-treated children. The group plans to follow children for 6 years from the time treatment is initiated, allowing investigators to determine cumulative vertebral fracture rates and the potential for bone mass restitution and reshaping of fractured vertebral bodies.
Dr. Ward recommends children with rheumatic diseases undergo baseline spine radiographs at the time of diagnosis and then annually, or more frequently if they have new onset back pain. Children with vertebral fractures who are symptomatic (i.e., have back pain) may be candidates for bisphosphonate therapy, she said.
Dr. Ward reported having a business relationship with Novartis.
Fracture (L1), seen in a girl on chronic steroids for JDM.
Source Courtesy Dr. Leanne M. Ward
PHILADELPHIA — Vertebral fractures are present in a significant percentage of children with rheumatic diseases, and these fractures appear prior to prolonged glucocorticoid exposure, according to Dr. Leanne M. Ward.
“Vertebral fractures are an underrecognized complication of steroid-treated rheumatic disorders,” said Dr. Ward, director of the Pediatric Bone Health Clinical and Research Programs at University of Ottawa. “But when do the fractures first occur—in the course of the disease or steroid treatment.”
Investigators from the Canadian STOPP (Steroid-Associated Osteoporosis in the Pediatric Population) Consortium evaluated the spine health of 134 children (89 girls, median age 10 years) with rheumatic conditions. Thirty children had juvenile dermatomyositis (JDM), 28 had juvenile idiopathic arthritis (JIA) excluding systemic JIA, and 76 were diagnosed with other rheumatic disorders (systemic lupus erythematosus, systemic vasculitides, systemic JIA, and others). The children underwent thoracolumbar spine x-rays and lumbar spine areal bone mineral density (LS aBMD) evaluation within 30 days of beginning glucocorticoid therapy.
Seven percent of the group (9 of 134) had vertebral fractures; in these 9 children, 6 patients had a single vertebral fracture, while 3 patients had between 2 and 5 fractures, for a total of 13 fractures. Three of the fractures (23%) were moderate, and the rest were deemed mild. Most fractures were located in the mid-thoracic and upper lumbar regions, said Dr. Ward, who presented the findings at the annual meeting of the American College of Rheumatology.
Although the mean LS aBMD scores for the group were lower compared with the norm (−0.6 plus or minus 1.22, P<.001), LS aBMD did not predict the development of vertebral fractures. The odds for fracture were increased 10-fold if the child reported back pain.
The STOPP Consortium was founded in 2003 as a Canadian national pediatric bone health working group of investigators from 12 tertiary children's hospitals. Its main focus is to track bone mineral accrual and incident spine fractures in glucocorticoid-treated children. The group plans to follow children for 6 years from the time treatment is initiated, allowing investigators to determine cumulative vertebral fracture rates and the potential for bone mass restitution and reshaping of fractured vertebral bodies.
Dr. Ward recommends children with rheumatic diseases undergo baseline spine radiographs at the time of diagnosis and then annually, or more frequently if they have new onset back pain. Children with vertebral fractures who are symptomatic (i.e., have back pain) may be candidates for bisphosphonate therapy, she said.
Dr. Ward reported having a business relationship with Novartis.
Fracture (L1), seen in a girl on chronic steroids for JDM.
Source Courtesy Dr. Leanne M. Ward
PHILADELPHIA — Vertebral fractures are present in a significant percentage of children with rheumatic diseases, and these fractures appear prior to prolonged glucocorticoid exposure, according to Dr. Leanne M. Ward.
“Vertebral fractures are an underrecognized complication of steroid-treated rheumatic disorders,” said Dr. Ward, director of the Pediatric Bone Health Clinical and Research Programs at University of Ottawa. “But when do the fractures first occur—in the course of the disease or steroid treatment.”
Investigators from the Canadian STOPP (Steroid-Associated Osteoporosis in the Pediatric Population) Consortium evaluated the spine health of 134 children (89 girls, median age 10 years) with rheumatic conditions. Thirty children had juvenile dermatomyositis (JDM), 28 had juvenile idiopathic arthritis (JIA) excluding systemic JIA, and 76 were diagnosed with other rheumatic disorders (systemic lupus erythematosus, systemic vasculitides, systemic JIA, and others). The children underwent thoracolumbar spine x-rays and lumbar spine areal bone mineral density (LS aBMD) evaluation within 30 days of beginning glucocorticoid therapy.
Seven percent of the group (9 of 134) had vertebral fractures; in these 9 children, 6 patients had a single vertebral fracture, while 3 patients had between 2 and 5 fractures, for a total of 13 fractures. Three of the fractures (23%) were moderate, and the rest were deemed mild. Most fractures were located in the mid-thoracic and upper lumbar regions, said Dr. Ward, who presented the findings at the annual meeting of the American College of Rheumatology.
Although the mean LS aBMD scores for the group were lower compared with the norm (−0.6 plus or minus 1.22, P<.001), LS aBMD did not predict the development of vertebral fractures. The odds for fracture were increased 10-fold if the child reported back pain.
The STOPP Consortium was founded in 2003 as a Canadian national pediatric bone health working group of investigators from 12 tertiary children's hospitals. Its main focus is to track bone mineral accrual and incident spine fractures in glucocorticoid-treated children. The group plans to follow children for 6 years from the time treatment is initiated, allowing investigators to determine cumulative vertebral fracture rates and the potential for bone mass restitution and reshaping of fractured vertebral bodies.
Dr. Ward recommends children with rheumatic diseases undergo baseline spine radiographs at the time of diagnosis and then annually, or more frequently if they have new onset back pain. Children with vertebral fractures who are symptomatic (i.e., have back pain) may be candidates for bisphosphonate therapy, she said.
Dr. Ward reported having a business relationship with Novartis.
Fracture (L1), seen in a girl on chronic steroids for JDM.
Source Courtesy Dr. Leanne M. Ward