Osteoporotic Fractures and Vertebral Body Reshaping in Children with Glucocorticoid-Treated Rheumatic Disorders.

PURPOSE To evaluate the incidence and predictors of osteoporotic fractures and potential for recovery over six years following glucocorticoid (GC) initiation in children with rheumatic disorders. METHODS Children with GC-treated rheumatic disorders were evaluated through a prospective inception cohort study led by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium. Clinical outcomes included lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-VF, and vertebral body reshaping. RESULTS 136 children with GC-treated rheumatic disorders were enrolled (mean age 9.9 years, SD 4.4). The six-year cumulative fracture incidence was 16.3% for VF, and 10.1% for non-VF. GC exposure was highest in the first six months, and 24/38 VF (63%) occurred in the first two years. Following VF, 16/19 children (84%) had complete vertebral body reshaping. Increases in disease activity and body mass index z-scores in the first year and declines in LS BMD z-scores in the first six months predicted incident VF over the six years, while higher average daily GC doses predicted both incident VF and non-VF. LS BMD z-scores were lowest at 6 months (mean -0.9, SD 1.2) and remained low by six years even when adjusted for height z-scores (-0.6, SD 0.9). CONCLUSIONS VF occurred early and were more common than non-VF in children with GC-treated rheumatic disorders. Eight-four percent of children with VF underwent complete vertebral body reshaping, while vertebral deformity persisted in the remainder of children. On average, LS BMD z-scores remained low at six years, consistent with incomplete recovery.