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

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Abstract

Summary

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%).

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

ABQ:

Algorithm-based qualitative

BMI:

Body Mass Index

BMD:

Bone mineral density

CI:

Confidence interval

GC:

Glucocorticoid

LS:

Lumbar spine

NS:

Nephrotic syndrome

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Acknowledgments

This study was primarily funded by an operating grant from the Canadian Institutes for Health Research. Additional funding for this work has been provided by the Canadian Institutes for Health Research New Investigator Program (to Dr. Leanne Ward), the Canadian Child Health Clinician Scientist Career Enhancement Program (to Dr. Leanne Ward), the Children's Hospital of Eastern Ontario, and Women and Children's Health Research Institute, University of Alberta.

In addition, the Canadian STOPP Consortium would like to thank the following individuals who contributed to the study: The children and their families who participated in the study, making the STOPP research program possible; the research associates who managed the study at the coordinating center (the Children's Hospital of Eastern Ontario Ottawa, Ontario): Elizabeth Sykes (STOPP project manager), Maya Scharke (STOPP data analyst and database manager), Monica Tomiak (statistical analyses), Victor Konji (STOPP publications and presentations committee liaison and hand morphometry measurements), Steve Anderson (Children's Hospital of Eastern Ontario, Pediatric Bone Health Program research manager), Catherine Riddell (STOPP national study monitor); and research associates who took care of the patients from the following institutions: Alberta Children's Hospital, Calgary, Alberta—Eileen Pyra; British Columbia Children's Hospital, Vancouver British Columbia—Terry Viczko, Sandy Hwang; Children's Hospital of Eastern Ontario, Ottawa, Ontario—Heather Cosgrove, Amanda George, Josie MacLennan, Catherine Riddell; Children's Hospital of Western Ontario, London, Ontario—Leila MacBean, Mala Ramu; McMaster Children's Hospital, Hamilton, Ontario—Susan Docherty-Skippen; IWK Health Center, Halifax, Nova Scotia—Aleasha Warner; Montréal Children's Hospital, Montréal, Québec—Diane Laforte, Maritza Laprise, Mayito St-Pierre; Ste. Justine Hospital, Montréal, Québec—Claude Belleville, Stéphanie Pellerin, Natacha Gaulin Marion; Stollery Children's Hospital, Edmonton, Alberta—Deborah Olmstead, Melissa Gabruck, Linda Manasterski; Toronto Hospital for Sick Children, Toronto, Ontario—Julie Lee, Karen Whitney; Winnipeg Children's Hospital, Winnipeg, Manitoba—Dan Catte, Erika Bloomfield. The research nurses, support staff, and all the STOPP collaborators from the various Divisions of Nephrology, Oncology, Rheumatology, and Radiology have contributed to the care of the children enrolled in the study.

Funding

The primary funding source is the Canadian Institutes of Health Research. Additional funding sources are from the Canadian Child Health Clinician Scientist Program; the Children's Hospital of Eastern Ontario Research Institute and Departments of Pediatrics and Surgery; and the Women and Children's Health Research Institute, University of Alberta.

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Pediatric Bone Health Clinical and Research Programs, Children s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada

    L. M. Ward

  2. Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    I. Gaboury & A. Ni

  3. Université de Montréal, Montréal, QC, Canada

    N. Alos

  4. McMaster University, Hamilton, ON, Canada

    S. Arora

  5. McGill University, Montréal, QC, Canada

    L. Bell, F. Rauch & C. Rodd

  6. University of Manitoba, Winnipeg, MB, Canada

    T. Blydt-Hansen

  7. University of Western Ontario, London, ON, Canada

    C. Clarson & G. Filler

  8. Brock University, St. Catharines, ON, Canada

    J. Hay

  9. University of Toronto, Toronto, ON, Canada

    D. Hebert

  10. University of British Columbia, Vancouver, BC, Canada

    B. Lentle

  11. University of Calgary, Calgary, AB, Canada

    J. Midgley

  12. University of Alberta, Edmonton, AB, Canada

    M. Pinsk & K. Siminoski

  13. University of Ottawa, Ottawa, ON, Canada

    J. Feber, M. Matzinger, D. Moher, N. Shenouda & L. M. Ward

Authors
  1. J. Feber
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  2. I. Gaboury
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  3. A. Ni
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  4. N. Alos
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  5. S. Arora
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  6. L. Bell
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  7. T. Blydt-Hansen
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  8. C. Clarson
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  9. G. Filler
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  10. J. Hay
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  11. D. Hebert
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  13. M. Matzinger
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  14. J. Midgley
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  15. D. Moher
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  16. M. Pinsk
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  17. F. Rauch
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  18. C. Rodd
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  19. N. Shenouda
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  20. K. Siminoski
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  21. L. M. Ward
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The Canadian STOPP Consortium

Corresponding author

Correspondence to L. M. Ward.

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Feber, J., Gaboury, I., Ni, A. et al. Skeletal findings in children recently initiating glucocorticoids for the treatment of nephrotic syndrome. Osteoporos Int 23, 751–760 (2012). https://doi.org/10.1007/s00198-011-1621-2

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  • DOI: https://doi.org/10.1007/s00198-011-1621-2

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