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Risk Factors for Corticosteroid-associated Osteonecrosis in Children: A National Database Study.

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Pediatric patients with certain conditions, including acute lymphoblastic leukemia and systemic lupus erythematosus, face higher risks of osteonecrosis when treated with corticosteroids. Targeted screening is crucial for identifying high-risk children receiving these medications.

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Area of Science:

  • Pediatric Rheumatology
  • Pediatric Oncology
  • Pediatric Immunology

Background:

  • Corticosteroid-associated osteonecrosis (CA-ONJ) is a serious complication causing pain and joint collapse.
  • While CA-ONJ is known in pediatric patients, identifying high-risk individuals across various conditions remains challenging.
  • This study aimed to pinpoint pediatric populations at elevated risk for CA-ONJ following corticosteroid therapy for autoimmune, inflammatory, and oncologic diseases.

Purpose of the Study:

  • To identify pediatric populations at high risk for developing osteonecrosis after corticosteroid treatment.
  • To analyze risk factors associated with corticosteroid-associated osteonecrosis in children across different medical conditions.

Main Methods:

  • Retrospective cohort study utilizing the Merative MarketScan Research Databases (2007-2022).
  • Identified pediatric patients receiving oral or intravenous corticosteroids.
  • Analyzed demographic, clinical, and prescription data using statistical tests and Cox proportional-hazards regression to determine risk factors for osteonecrosis.

Main Results:

  • Out of 5,606,781 pediatric patients on corticosteroids, 131 developed osteonecrosis (mean time to onset: 7.1 months).
  • Higher risk of osteonecrosis was associated with acute lymphoblastic leukemia (HR=575.82), systemic lupus erythematosus (HR=106.41), Crohn's disease (HR=6.67), juvenile idiopathic arthritis (HR=4.62), and solid organ transplant (HR=4.24).
  • Other significant risk factors included older age at corticosteroid initiation, longer total corticosteroid prescription duration, and use of dexamethasone.

Conclusions:

  • The study underscores the necessity for targeted screening of pediatric patients receiving high-dose corticosteroids.
  • Findings can inform multidisciplinary approaches and interventions for children undergoing corticosteroid treatment.
  • Further research into prospective screening and intervention protocols is recommended.