ICCBH2013 Oral Communications Chronic diseases (6 abstracts)
Vertebral fractures in the 3-year period following steroid initiation among children with chronic illnesses
P M Miettunen 1 , M Taljaard 2 , N Alos 3 , S Atkinson 4 , D Cabral 5 , C Clarson 6 , R Couch 7 , E A Cummings 8 , J Feber 2 , R M Grant 9 , B Lentle 5 , M Matzinger 2 , H Nadel 5 , C Rodd 10 , N Shenouda 2 , R Stein 6 , D Stephure 1 , S Taback 11 , F Rauch 10 , K Siminoski 7 , L M Ward 2 & the Canadian STOPP Consortium 12
1University of Calgary, Calgary, Alberta, Canada; 2University of Ottawa, Ottawa, Ontario, Canada; 3Université de Montréal, Montréal, Quebec, Canada; 4McMaster University, Hamilton, Ontario, Canada; 5University of British Columbia, Vancouver, British Columbia, Canada; 6University of Western Ontario, London, Ontario, Canada; 7University of Alberta, Edmonton, Alberta, Canada; 8Dalhousie University, Halifax, Nova Scotia, Canada; 9University of Toronto, Ontario, Canada; 10McGill University, Montréal, Quebec, Canada; 11University of Manitoba, Winnipeg, Manitoba, Canada; 12Canadian Pediatric Bone Health Working Group, Ottawa, Ontario, Canada.
Objectives: To describe the incidence of vertebral fractures in steroid-treated children.
Methods: Fractures were assessed prospectively each year for 3 years according to the Genant semi-quantitative method. Proportions of children with incident fractures were determined annually over the study period. To examine associations with baseline clinical factors, the 3-year total number of incident fractures was analyzed using multivariable Poisson regression.
Results: 404 children were enrolled at a median age of 6.2 years, range 1–17; 50% boys; 188 (46%) had leukemia, 136 (34%) rheumatic conditions, and 80 (20%) nephrotic syndrome. The baseline study visit occurred at a median of 18 days following steroid initiation (inter-quartile range 11–24 days). Overall, the prevalence of vertebral fractures at baseline was 11% (95% CI 8–14), and 19% of children (95% CI 15–24) had at least one incident fracture over the 3 years. Among those with incident fractures, 23/52 children (44%) had ≥1 moderate or severe fracture; in addition, 53/130 incident fractures (41%) were moderate or severe. Disease-specific results for baseline fracture prevalence and 3 year incidence were as follows: Leukemia: 16% (95% CI 11–21) and 25% (95% CI 19–33); rheumatic disorders: 7% (95% CI 4–12) and 14% (95% CI 9–22); nephrotic syndrome 8% (95% CI 4–16) and 11% (95% CI 4–25). The annual proportion of children with incident fractures peaked at 12 months and declined thereafter (P=0.04). In Poisson multivariable modeling assessing baseline clinical factors, the following were associated with higher fracture incidence: prevalent fractures (incidence rate ratio (RR) 6.3, 95% CI 3.2–12.4), female gender (RR 1.8; 95% CI 1.0–3.3), pre-pubertal status (RR 2.1; 95% CI 0.8–5.4), and lower BMD Z-scores (RR 1.4; 95% CI 1.1–1.7).
Conclusions: Within 3 years of steroid initiation, 19% of children had incident vertebral fractures. Fracture incidence peaked at 12 months, and almost half of the incident fractures were moderate or severe. Of the clinical factors measured at baseline, prevalent fractures were most strongly associated with fracture incidence over the study period.
Declaration of funding
Funded by CIHR FRN 64285.
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