Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disordersMembers of the Canadian STOPP Consortium are listed in Appendix A

ObjectiveVertebral fractures are an underrecognized problem in children with inflammatory disorders. We studied spine health among 134 children 87 girls with rheumatic conditions median age 10 years within 30 days of initiating glucocorticoid therapy.MethodsChildren were categorized as follows: juvenile dermatomyositis n 30, juvenile idiopathic arthritis n 28, systemic lupus erythematosus and related conditions n 26, systemic arthritis n 22, systemic vasculitis n 16, and other conditions n 12. Thoracolumbar spine radiograph and dual xray absorptiometry for lumbar spine Lspine areal bone mineral density BMD were performed within 30 days of glucocorticoid initiation. Genant semiquantitative grading was used for vertebral morphometry. Second metacarpal morphometry was carried out on a hand radiograph. Clinical factors including disease and physical activity, calcium and vitamin D intake, cumulative glucocorticoid dose, underlying diagnosis, Lspine BMD Z score, and back pain were analyzed for association with vertebral fracture.ResultsThirteen vertebral fractures were noted in 9 children 7. Of these, 6 patients had a single vertebral fracture and 3 had 2–3 fractures. Fractures were clustered in the midthoracic region 69. Three vertebral fractures 23 were moderate grade 2; the others were mild grade 1. For the entire cohort, mean ± SD Lspine BMD Z score was significantly different from zero −0.55 ± 1.2, P< 0.001 despite a mean height Z score that was similar to the healthy average 0.02 ± 1.0, P 0.825. Back pain was highly associated with increased odds for fracture odds ratio 10.6 95 confidence interval 2.1–53.8, P 0.004.ConclusionIn pediatric rheumatic conditions, vertebral fractures can be present prior to prolonged glucocorticoid exposure.