Bone Morbidity in Glucocorticoid-treated Children with Chronic Rheumatic Disease (CRD)

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Presentation Number:242

Poster Board Number:242

Presentation Time:11/8/2007 8:00:00 AM

Title: Bone Morbidity in Glucocorticoid-treated Children with Chronic

Rheumatic Disease (CRD)

Category:11. Pediatric rheumatology clinical and therapeutic disease

Author(s). A. Cabral1, B. Lang2, P. B. Dent3, J. Ellsworth4, A. M. Huber2,

C. LeBlanc5, P. M. Miettunen6, K. Oen7, S. E. Ramsey2, C. Saint-Cyr8, R.

Scuccimarri9, J. Hay10, M. Matzinger5, N. Shenouda5, L. M. Ward5, and the

STOPP Consortium. 1U of British Columbia, Vancouver, BC, Canada; 2Dalhousie

Univ, Halifax, NS, Canada; 3McMaster Univ, Hamilton, ON, Canada; 4U of

Alberta, Edmonton, AB, Canada; 5U of Ottawa, Ottawa, ON, Canada; 6U of

Calgary, Calgary, AB, Canada; 7U of Manitoba, Winnipeg, MB, Canada; 8U de

Montréal, Montréal, QC, Canada; 9McGill Univ, Montréal, QC, Canada; 10Brock

Univ, St. Catharines, ON, Canada

Aims Children with CRD are at risk for compromised bone health from factors

that include underlying disease and glucocorticoid (GC) use. The

STeroid-induced Osteoporosis in the Pediatric Population (STOPP) study

involving 10 Canadian tertiary pediatric centres aims to prospectively

evaluate the magnitude and rate of bone mineral density (BMD) and content

(BMC) changes after initiating GC in CRD patients, and to identify and

characterize atraumatic fractures.

Methods Children (≤ 16y) initiating GC for treatment of CRD since Jan 2005

were eligible for inclusion. Enrolled patients had baseline (< 30 days) and

6-monthly (6m) BMD/BMC studies; x-rays of lateral spine at baseline and for

clinically suspected fractures; baseline plus 3 monthly assessment of

medications, disease activity (10 cm visual analog scale) and 2-day physical

activity (Habitual Activity Estimation Scale).

Results We report on 66 (20 male, mean (SD) age 9.6 (4.4) years) of 101

patients with 6m minimum followup whose diagnoses were juvenile idiopathic

arthritis (JIA) 32%, juvenile dermatomyositis (JDM) 29%, systemic lupus

erythematosus (SLE)/connective tissue disorders 21% and chronic vasculitis

18%.

Median disease durations from symptom onset to enrollment were: 104, 134,

185 and 95 days respectively. At baseline 3 (4.5%) patients (JIA, SLE, JDM)

had vertebral compression fractures, only JDM being symptomatic. By 6m there

were no additional symptomatic fractures. The baseline mean areal spine BMD

z score of -0.6 (1.1) was significantly below the healthy average despite

normal height z scores.

Changes between baseline and 6m included the following: a mean reduction of

2.8% in spine volumetric BMD; an absolute decrease in spine BMC in 39 (64%)

patients (mean reduction of 7.4% ) in this subgroup); a decrease in median

disease activity score from 6.4 to 1.6; an increase in overall median hours

of physical activity from 11.9 to 16.2; and a decrease in median hours of

inactivity from 15.2 to 11.5. The median daily prednisone dose fell from the

first to the second 3 months from 1.4 to 0.3 mg/kg.

Conclusions At the time of GC initiation children with CRD may already have

atraumatic fractures and a lower than average BMD. By 6m despite reduced

disease activity and increased physical activity they have further bone

morbidity manifested by a drop in spinal volumetric BMD, and an absolute

loss of spine BMC in a majority. The long term fracture risk versus

potential for bone mass restitution remains to be determined.

Disclosures: D.A. Cabral, None; B. Lang, None; P.B. Dent, None; J.

Ellsworth, None; A.M. Huber, None; C. LeBlanc, None; P.M. Miettunen, None;

K. Oen, None; S.E. Ramsey, None; C. Saint-Cyr, None; R. Scuccimarri, None;

J. Hay, None; M. Matzinger, None; N. Shenouda, None; L.M. Ward, None.