UNLABELLED: Incident vertebral fractures and lumbar spine bone mineral density (BMD) were assessed in the 12 months following glucocorticoid initiation in 65 children with nephrotic syndrome. The incidence of vertebral fractures was low at 12 months (6 %) and most patients demonstrated recovery in BMD Z-scores by this time point. INTRODUCTION: Vertebral fracture (VF) incidence following glucocorticoid (GC) initiation has not been previously reported in pediatric nephrotic syndrome. METHODS: VF was assessed on radiographs (Genant method); lumbar spine bone mineral density (LS BMD) was evaluated by dual-energy X-ray absorptiometry. RESULTS: Sixty-five children were followed to 12 months post-GC initiation (median age, 5.4 years; range, 2.3-17.9). Three of 54 children with radiographs (6 %; 95 % confidence interval (CI), 2-15 %) had incident VF at 1 year. The mean LS BMD Z-score was below the healthy average at baseline (mean ± standard deviation (SD), -0.5 ± 1.1; p = 0.001) and at 3 months (-0.6 ± 1.1; p < 0.001), but not at 6 months (-0.3 ± 1.3; p = 0.066) or 12 months (-0.3 ± 1.2; p = 0.066). Mixed effect modeling showed a significant increase in LS BMD Z-scores between 3 and 12 months (0.22 SD; 95 % CI, 0.08 to 0.36; p = 0.003). A subgroup (N = 16; 25 %) had LS BMD Z-scores that were ≤-1.0 at 12 months. In these children, each additional 1,000 mg/m(2) of GC received in the first 3 months was associated with a decrease in LS BMD Z-score by 0.39 at 12 months (95 % CI, -0.71 to -0.07; p = 0.017). CONCLUSIONS: The incidence of VF at 1 year was low and LS BMD Z-scores improved by 12 months in the majority. Twenty-five percent of children had LS BMD Z-scores ≤-1.0 at 12 months. In these children, LS BMD Z-scores were inversely associated with early GC exposure, despite similar GC exposure compared to the rest of the cohort.
UNLABELLED: Incident vertebral fractures and lumbar spine bone mineral density (BMD) were assessed in the 12 months following glucocorticoid initiation in 65 children with nephrotic syndrome. The incidence of vertebral fractures was low at 12 months (6 %) and most patients demonstrated recovery in BMD Z-scores by this time point. INTRODUCTION:Vertebral fracture (VF) incidence following glucocorticoid (GC) initiation has not been previously reported in pediatric nephrotic syndrome. METHODS:VF was assessed on radiographs (Genant method); lumbar spine bone mineral density (LS BMD) was evaluated by dual-energy X-ray absorptiometry. RESULTS: Sixty-five children were followed to 12 months post-GC initiation (median age, 5.4 years; range, 2.3-17.9). Three of 54 children with radiographs (6 %; 95 % confidence interval (CI), 2-15 %) had incident VF at 1 year. The mean LS BMD Z-score was below the healthy average at baseline (mean ± standard deviation (SD), -0.5 ± 1.1; p = 0.001) and at 3 months (-0.6 ± 1.1; p < 0.001), but not at 6 months (-0.3 ± 1.3; p = 0.066) or 12 months (-0.3 ± 1.2; p = 0.066). Mixed effect modeling showed a significant increase in LS BMD Z-scores between 3 and 12 months (0.22 SD; 95 % CI, 0.08 to 0.36; p = 0.003). A subgroup (N = 16; 25 %) had LS BMD Z-scores that were ≤-1.0 at 12 months. In these children, each additional 1,000 mg/m(2) of GC received in the first 3 months was associated with a decrease in LS BMD Z-score by 0.39 at 12 months (95 % CI, -0.71 to -0.07; p = 0.017). CONCLUSIONS: The incidence of VF at 1 year was low and LS BMD Z-scores improved by 12 months in the majority. Twenty-five percent of children had LS BMD Z-scores ≤-1.0 at 12 months. In these children, LS BMD Z-scores were inversely associated with early GC exposure, despite similar GC exposure compared to the rest of the cohort.
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: Colin E Webber; Lesley F Beaumont; Judy Morrison; Alessandra Sala; Ronald D Barr Journal: Can Assoc Radiol J Date: 2007-02 Impact factor: 2.248
Authors: Cynthia L Ogden; Robert J Kuczmarski; Katherine M Flegal; Zuguo Mei; Shumei Guo; Rong Wei; Laurence M Grummer-Strawn; Lester R Curtin; Alex F Roche; Clifford L Johnson Journal: Pediatrics Date: 2002-01 Impact factor: 7.124
Authors: Mary B Leonard; Harold I Feldman; Justine Shults; Babette S Zemel; Bethany J Foster; Virginia A Stallings Journal: N Engl J Med Date: 2004-08-26 Impact factor: 91.245
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
Authors: David R Weber; Alison Boyce; Catherine Gordon; Wolfgang Högler; Heidi H Kecskemethy; Madhusmita Misra; Diana Swolin-Eide; Peter Tebben; Leanne M Ward; Halley Wasserman; Christopher Shuhart; Babette S Zemel Journal: J Clin Densitom Date: 2019-07-10 Impact factor: 2.617
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: 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