SUMMARY: Eighty children with nephrotic syndrome underwent lumbar spine densitometry and vertebral morphometry soon after glucocorticoid initiation. We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%). INTRODUCTION: Vertebral fractures are an under-recognized complication of childhood glucocorticoid-treated illnesses. Our goal was to study the relationships among glucocorticoid exposure, lumbar spine areal BMD (LS BMD), and vertebral shape in glucocorticoid-treated children with new-onset nephrotic syndrome. METHODS: Lateral thoracolumbar spine radiography and LS BMD were performed in 80 children with nephrotic syndrome (median age 4.4 years; 46 boys) within the first 37 days of glucocorticoid therapy. Genant semiquantitative grading was used as the primary method for vertebral morphometry; the algorithm-based qualitative (ABQ) method was used for secondary vertebral deformity analysis. RESULTS: Six of the 78 children with usable radiographs (8%; 95% confidence interval 4 to 16%) manifested a single Genant grade 1 deformity each. All deformities were mild anterior wedging (two at each of T6, T7, and T8). Four of the 78 children (5%; 95% confidence interval 2 to 13%) showed one ABQ sign of fracture each (loss of endplate parallelism; two children at T6 and two at T8). Two of the children with ABQ signs also had a Genant grade 1 deformity in the same vertebral body. None of the children with a Genant or ABQ deformity reported back pain. An inverse relationship was identified between LS BMD Z-score and glucocorticoid exposure. CONCLUSIONS: Although we identified an inverse relationship between steroid exposure and LS BMD soon after glucocorticoid initiation for childhood nephrotic syndrome, there was only a low rate of vertebral deformities. The clinical significance of these findings requires further study.
SUMMARY: Eighty children with nephrotic syndrome underwent lumbar spine densitometry and vertebral morphometry soon after glucocorticoid initiation. We found an inverse relationship between glucocorticoid exposure and spine areal bone mineral density (BMD) Z-score and a low rate of vertebral deformities (8%). INTRODUCTION:Vertebral fractures are an under-recognized complication of childhood glucocorticoid-treated illnesses. Our goal was to study the relationships among glucocorticoid exposure, lumbar spine areal BMD (LS BMD), and vertebral shape in glucocorticoid-treated children with new-onset nephrotic syndrome. METHODS: Lateral thoracolumbar spine radiography and LS BMD were performed in 80 children with nephrotic syndrome (median age 4.4 years; 46 boys) within the first 37 days of glucocorticoid therapy. Genant semiquantitative grading was used as the primary method for vertebral morphometry; the algorithm-based qualitative (ABQ) method was used for secondary vertebral deformity analysis. RESULTS: Six of the 78 children with usable radiographs (8%; 95% confidence interval 4 to 16%) manifested a single Genant grade 1 deformity each. All deformities were mild anterior wedging (two at each of T6, T7, and T8). Four of the 78 children (5%; 95% confidence interval 2 to 13%) showed one ABQ sign of fracture each (loss of endplate parallelism; two children at T6 and two at T8). Two of the children with ABQ signs also had a Genant grade 1 deformity in the same vertebral body. None of the children with a Genant or ABQ deformity reported back pain. An inverse relationship was identified between LS BMD Z-score and glucocorticoid exposure. CONCLUSIONS: Although we identified an inverse relationship between steroid exposure and LS BMD soon after glucocorticoid initiation for childhood nephrotic syndrome, there was only a low rate of vertebral deformities. The clinical significance of these findings requires further study.
Authors: Jeffrey R Curtis; Andrew O Westfall; Jeroan Allison; Johannes W Bijlsma; Allison Freeman; Varghese George; Stacey H Kovac; Claire M Spettell; Kenneth G Saag Journal: Arthritis Rheum Date: 2006-06-15
Authors: Jacob L Jaremko; Kerry Siminoski; Gregory B Firth; Mary Ann Matzinger; Nazih Shenouda; Victor N Konji; Johannes Roth; Anne Marie Sbrocchi; Martin H Reed; Mary Kathleen O'Brien; Helen Nadel; Scott McKillop; Reinhard Kloiber; Josée Dubois; Craig Coblentz; Martin Charron; Leanne M Ward Journal: Pediatr Radiol Date: 2015-04-01
Authors: K Siminoski; K-C Lee; H Jen; R Warshawski; M A Matzinger; N Shenouda; M Charron; C Coblentz; J Dubois; R Kloiber; H Nadel; K O'Brien; M Reed; K Sparrow; C Webber; B Lentle; L M Ward Journal: Osteoporos Int Date: 2011-11-23 Impact factor: 4.507
Authors: J Ma; H J McMillan; G Karagüzel; C Goodin; J Wasson; M A Matzinger; P DesClouds; D Cram; M Page; V N Konji; B Lentle; L M Ward Journal: Osteoporos Int Date: 2016-10-24 Impact factor: 4.507
Authors: Claire M A LeBlanc; Jinhui Ma; Monica Taljaard; Johannes Roth; Rosie Scuccimarri; Paivi Miettunen; Bianca Lang; Adam M Huber; Kristin Houghton; Jacob L Jaremko; Josephine Ho; Nazih Shenouda; Mary Ann Matzinger; Brian Lentle; Robert Stein; Anne Marie Sbrocchi; Kiem Oen; Celia Rodd; Roman Jurencak; Elizabeth A Cummings; Robert Couch; David A Cabral; Stephanie Atkinson; Nathalie Alos; Frank Rauch; Kerry Siminoski; Leanne M Ward Journal: J Bone Miner Res Date: 2015-05-26 Impact factor: 6.741
Authors: K Siminoski; K-C Lee; S Abish; N Alos; L Bell; T Blydt-Hansen; R Couch; E A Cummings; J Ellsworth; J Feber; C V Fernandez; J Halton; A M Huber; S Israels; R Jurencak; B Lang; C Laverdière; C LeBlanc; V Lewis; J Midgley; P M Miettunen; K Oen; V Phan; M Pinsk; F Rauch; C Rodd; J Roth; C Saint-Cyr; R Scuccimarri; D Stephure; S Taback; B Wilson; L M Ward Journal: Osteoporos Int Date: 2012-06-29 Impact factor: 4.507
Authors: Anne Tsampalieros; Pooja Gupta; Michelle R Denburg; Justine Shults; Babette S Zemel; Sogol Mostoufi-Moab; Rachel J Wetzsteon; Rita M Herskovitz; Krista M Whitehead; Mary B Leonard Journal: J Bone Miner Res Date: 2013-03 Impact factor: 6.741