Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome

V. Phan, T. Blydt-Hansen, J. Feber, N. Alos, S. Arora, S. Atkinson, L. Bell, C. Clarson, R. Couch, E. A. Cummings, G. Filler, R. M. Grant, J. Grimmer, D. Hebert, B. Lentle, J. Ma, M. Matzinger, J. Midgley, M. Pinsk, C. RoddN. Shenouda, R. Stein, D. Stephure, S. Taback, K. Williams, F. Rauch, K. Siminoski, Leanne M. Ward, Jacqueline Halton, Roman Jurencak, Johannes Roth, David Moher, Tim Ramsay, Reinhard Kloiber, Victor Lewis, Paivi Miettunen, David Cabral, David B. Dix, Kristin Houghton, Helen R. Nadel, John Hay, Elizabeth Cairney, Keith Sparrow, Conrad Fernandez, Adam M. Huber, Bianca Lang, Kathy O'Brien, Ronald Barr, Craig Coblentz, Peter B. Dent, Maggie Larche, Colin Webber, Sharon Abish, Rosie Scuccimarri, Francis Glorieux, Josée Dubois, Caroline Laverdière, Claire Saint-Cyr, Janet Ellsworth, Claire LeBlanc, Beverly Wilson, Martin Charron, Isabelle Gaboury, Sara Israels, Kiem Oen, Martin Reed

Research output: Contribution to journalArticlepeer-review

49 Citations (Scopus)

Abstract

Summary: 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.

Original languageEnglish
Pages (from-to)627-637
Number of pages11
JournalOsteoporosis International
Volume25
Issue number2
DOIs
Publication statusPublished - Feb 2014
Externally publishedYes

Bibliographical note

Funding Information:
This study was primarily funded by an operating grant from the Canadian Institutes for Health Research (FRN 64285). Additional funding for this work has been provided to Dr. Leanne Ward by the Canadian Institutes for Health Research New Investigator Program, the Canadian Child Health Clinician Scientist Career Enhancement Program, a University of Ottawa Research Chair Award and the CHEO Departments of Pediatrics and Surgery. This work was also supported by the Children's Hospital of Eastern Ontario Research Institute and the University of Alberta Women and Children's Health Research Institute.

ASJC Scopus Subject Areas

  • Endocrinology, Diabetes and Metabolism

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

Fingerprint

Dive into the research topics of 'Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome'. Together they form a unique fingerprint.

Cite this

Phan, V., Blydt-Hansen, T., Feber, J., Alos, N., Arora, S., Atkinson, S., Bell, L., Clarson, C., Couch, R., Cummings, E. A., Filler, G., Grant, R. M., Grimmer, J., Hebert, D., Lentle, B., Ma, J., Matzinger, M., Midgley, J., Pinsk, M., ... Reed, M. (2014). Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome. Osteoporosis International, 25(2), 627-637. https://doi.org/10.1007/s00198-013-2466-7