Osteoporotic Fractures and Vertebral Body Reshaping in Children With Glucocorticoid-treated Rheumatic Disorders

Area of Science:

• Pediatric rheumatology
• Pediatric endocrinology
• Pediatric orthopedics

Background:

• Osteoporotic fractures are a significant cause of morbidity in children with rheumatic disorders receiving glucocorticoid (GC) therapy.
• Understanding fracture incidence and recovery is crucial for managing these young patients.

Purpose of the Study:

• To evaluate the incidence and predictors of osteoporotic fractures in children with rheumatic disorders treated with GCs.
• To assess the potential for recovery from these fractures over a six-year period following GC initiation.

Main Methods:

• A prospective inception cohort study was conducted by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium.
• 136 children with GC-treated rheumatic disorders were enrolled, with clinical outcomes including lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-vertebral fractures (non-VF), and vertebral body reshaping tracked over six years.

Main Results:

• The 6-year cumulative incidence of fractures was 16.3% for VF and 10.1% for non-VF.
• Higher GC doses, increased disease activity, and BMI z-scores in the first year predicted incident VF. Declines in LS BMD z-scores within the first 6 months also predicted VF.
• While 84% of children with VF showed complete vertebral body reshaping, LS BMD z-scores remained low at 6 years, indicating incomplete recovery.

Conclusions:

• Vertebral fractures are common and occur early in children with GC-treated rheumatic disorders.
• Complete vertebral body reshaping occurs in most cases, but bone mineral density deficits persist, suggesting long-term implications.
• Early disease activity, BMI changes, and GC exposure are predictors of fracture risk, highlighting the need for proactive management strategies.