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- Title
Vertebral Body Reshaping after Fractures: An Important Index of Recovery in Glucocorticoid-Treated Children.
- Authors
Jinhui Ma; Siminoski, Kerry; Jaremko, Jacob L.; Koujok, Khaldoun; Matzinger, Mary Ann; Shenouda, Nazih; Wilson, Nagwa; Cheng, Megan; Alos, Nathalie; Atkinson, Stephanie; Cummings, Elizabeth A.; Ho, Josephine; Rodd, Celia; Sbrocchi, Anne Marie; Stein, Robert; Barr, Ronald; Cairney, Elizabeth; Dix, David B.; Fernandez, Conrad V.; Grant, Ronald
- Abstract
Purpose: In this 6-year study we identified factors associated with spontaneous vertebral body reshaping in glucocorticoid (GC)-treated children with leukemia, rheumatic disorders, and nephrotic syndrome. Methods: Subjects were 79 children (mean age 7.4 years) who had vertebral fracture (VF) evaluation on lateral spine radiographs at least 1 year after VF detection. VF were graded using the modified Genant semiquantitative method and fracture burden for individuals was quantified using the spinal deformity index (SDI; sum of grades from T4 to L4). Results: Sixty-five children (82.3%) underwent complete vertebral body reshaping (median time from VF detection to complete reshaping 1.3 years by Cox proportional hazard modeling). Of 237 VF, the majority (83.1%) ultimately reshaped, with 87.2% reshaping in the thoracic region vs 70.7% in the lumbar region (P = .004). Cox models showed that (1) every g/m² increase in GC exposure in the first year after VF detection was associated with a 19% decline in the probability of reshaping; (2) each unit increase in the SDI at the time of VF detection was associated with a 19% decline in the probability of reshaping [hazard ratio (HR) = 0.81; 95% confidence interval (CI) = 0.71, 0.92; P = .001]; (3) each additional VF present at the time of VF detection reduced reshaping by 25% (HR = 0.75; 95% CI = 0.62, 0.90; P = .002); and (4) each higher grade of VF severity decreased reshaping by 65% (HR = 0.35; 95% CI = 0.21, 0.57; P < .001). Conclusion: After experiencing a VF, children with higher GC exposure, higher SDI, more severe fractures, or lumbar VF were at increased risk for persistent vertebral deformity.
- Subjects
INTERVERTEBRAL disk surgery; GLUCOCORTICOIDS; CHILDREN'S health
- Publication
Journal of Clinical Endocrinology & Metabolism, 2024, Vol 109, Issue 3, pe1225
- ISSN
0021-972X
- Publication type
Article
- DOI
10.1210/clinem/dgad611