ICCBH2019 Poster Presentations (1) (226 abstracts)
Bone mass and vertebral fractures in South African (SA) children on prolonged oral glucocorticoids (GCs) for chronic non-malignant illnesses
Kebashni Thandrayen , Karen Petersen , Udai Kala , Nilesh Lala , Priya Ambaram , Bhadrish Mistry , Marc Hauptfleisch , Christina Hajinicolaou , Grace Okudu , Charl Verwey , Fatima Moosa , Kiran Parbhoo & John M Pettifor
Department of Paediatrics, Faculty of Health Sciences, C.H Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Objectives: To assess lumbar spine (LS) BMD Z-scores and the prevalence of vertebral fractures using DXA lateral vertebral (VFA) assessment in children and adolescents with chronic illnesses on GCs.
Methods: All children between the ages of 5 and 17 years with chronic non-malignant illnesses who were on GCs (intravenous or oral) for greater than 3 months duration were evaluated. Study participants were children attending the paediatric sub-specialty clinics at Chris Hani Baragwanath Academic hospital between 21 January 2016 and 17 January 2019. Information on the primary diagnosis, anthropometric measurements and medications prescribed and their dosages were recorded at time of evaluation. DXA scans of lumbar spine (LS) and lateral vertebral fracture (VFA) assessment were performed using a Hologic Discovery (Software version Apex 4.0.2) with its white male and female reference values. Calcium, phosphate, alkaline phosphatase (ALP) and serum 25-hydroxyvitamin D (25(OH)D) were measured.
Results: Sixty-four patients (45% with renal, 23% with rheumatic, 16% with neurological, 13% with hepatic and 3% with respiratory conditions; mean age 11.5±3.3 years, 56% boys, 92% SA black) were enrolled following informed consent from a guardian. The median duration of steroid treatment was 29.3 (IQR 14.6–46) months with a minimum duration of 3.7 months. Mean LS BMD Z-score was −1.66±1.1. Forty-one percent of patients had a LS BMD Z-score ≤ −2. The prevalence of vertebral fractures on VFA was 17% (11 of 64 patients) of whom 5/11 had a LS BMD Z-score ≤ −2. Median serum calcium, phosphate, PTH and ALP were normal. Majority of patients (34/38) had 25(OH)D levels > 30 nmol/l and, one of the four patients with vitamin D deficiency had a LS BMD Z-score ≤ −2. No patients with vitamin D deficiency had vertebral fractures.
Conclusion: Despite the lower prevalence of fractures in healthy black children compared to white children in South Africa, the prevalence of vertebral fractures in predominantly SA black children on GCs with chronic non-malignant illnesses is high (17%) suggesting that routine yearly DXA scans including VFA is warranted in this highly at risk population.
Disclosure: This study was supported by the South African Medical Research Council (SAMRC) Self-Initiated Research grant.
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