Long-Term Bone Health in Glucocorticoid-Treated Children with Rheumatic Diseases

  • Isabelle Rousseau-Nepton
  • Bianca Lang
  • Celia Rodd
PEDIATRIC RHEUMATOLOGY (TJA LEHMAN, SECTION EDITOR)
Part of the following topical collections:
  1. Topical Collection on Pediatric Rheumatology

Abstract

Glucocorticoids (GC) are a standard treatment for pediatric rheumatic disease. Recent literature highlights skeletal vulnerability in children with rheumatic illness, including vertebral and peripheral fractures and reductions in bone mineral density in longitudinal follow-up. Annual vertebral fracture incidence of 4–6 % in those recently diagnosed and prevalence of 7–28 % in those several years post diagnosis have been reported. The fractures are often asymptomatic, often thoracic in location, and usually of mild, anterior wedge morphology. Diseases with more systemic involvement and severe inflammation (SLE, JDM) seem to be at higher risk. Neither BMD nor GC dose are ideal predictors for risk of fractures. These children also seem to have an increased incidence of long-bone fractures, particularly in the forearm and wrist; in the scant literature, long-bone fractures are not predictive of vertebral fractures. Bone mass accrual is typically suboptimum across time, although the use of potent steroid-sparing anti-inflammatory agents may counteract the effects of GC and active disease. Vitamin D insufficiency warrants ongoing monitoring. Additional targeted studies are justified to increase understanding of bone health risks in this population.

Keywords

Glucocorticoids Vertebral fractures Fragility fractures Osteoporosis Low bone mass Hypovitaminosis D Vitamin D BMD DXA Bone health Long-term bone health Children Rheumatic diseases 

Abbreviations

aBMD

Areal bone mineral density

BMAD

Apparent bone mineral density

BMD

Bone mineral density

BMI

Body mass index

D

Day

DMARDs

Disease-modifying antirheumatic drugs

DXA

Dual-energy X-ray absorptiometry

GC

Glucocorticoids

JIA

Juvenile idiopathic arthritis

JDM

Juvenile dermatomyositis

kg

Kilogram

L

Lumbar

MCTD

Mixed connective tissue disease

SLE

Systemic lupus erythematosus

T

Thoracic

VF

Vertebral fractures

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Isabelle Rousseau-Nepton
    • 1
  • Bianca Lang
    • 2
  • Celia Rodd
    • 1
  1. 1.Pediatric Endocrinology, Department of PediatricsMontreal Children’s HospitalMontrealCanada
  2. 2.Division of Rheumatology, Department of Pediatrics, IWK Health CenterDalhousie UniversityHalifaxCanada

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