Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome

被引：58

作者：

Feber, J. ^{[1
,2
,14
]}

Gaboury, I.

Ni, A.

Alos, N. ^{[3
]}

Arora, S. ^{[4
]}

Bell, L. ^{[5
]}

Blydt-Hansen, T. ^{[6
]}

Clarson, C. ^{[7
]}

Filler, G. ^{[7
]}

Hay, J. ^{[8
]}

Hebert, D. ^{[9
]}

Lentle, B. ^{[10
]}

Matzinger, M. ^{[14
]}

Midgley, J. ^{[11
]}

Moher, D. ^{[14
]}

Pinsk, M. ^{[12
]}

Rauch, F. ^{[5
]}

Rodd, C. ^{[5
]}

Shenouda, N. ^{[14
]}

Siminoski, K. ^{[12
]}

Ward, L. M. ^{[14
]}

机构：

[1] Childrens Hosp Eastern Ontario, Pediat Bone Hlth Clin Program, Ottawa, ON K1H 8L1, Canada

[2] Childrens Hosp Eastern Ontario, Res Program, Ottawa, ON K1H 8L1, Canada

[3] Univ Montreal, Montreal, PQ, Canada

[4] McMaster Univ, Hamilton, ON, Canada

[5] McGill Univ, Montreal, PQ, Canada

[6] Univ Manitoba, Winnipeg, MB, Canada

[7] Univ Western Ontario, London, ON, Canada

[8] Brock Univ, St Catharines, ON L2S 3A1, Canada

[9] Univ Toronto, Toronto, ON, Canada

[10] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[11] Univ Calgary, Calgary, AB, Canada

[12] Univ Alberta, Edmonton, AB, Canada

[13] Natl Pediat Bone Hlth Working Grp, Ottawa, ON, Canada

[14] Univ Ottawa, Ottawa, ON, Canada

来源：

OSTEOPOROSIS INTERNATIONAL | 2012年 / 23卷 / 02期

基金：

加拿大健康研究院;

关键词：

Bone mineral density; Children; Glucocorticoids; Nephrotic syndrome; Vertebral deformities; BONE-MINERAL DENSITY; PREVALENT VERTEBRAL FRACTURES; JUVENILE IDIOPATHIC ARTHRITIS; OSTEOPOROTIC FRACTURES; PEDIATRIC POPULATION; PUBERTAL CHANGES; LONG-TERM; THERAPY; RISK; CORTICOSTEROIDS;

D O I：

10.1007/s00198-011-1621-2

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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%). 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. 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. 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. 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.

引用

页码：751 / 760

页数：10

共 45 条

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