Incident Vertebral Fractures and Risk Factors in the First Three Years Following Glucocorticoid Initiation Among Pediatric Patients With Rheumatic Disorders
Claire LeBlancJinhui MaMonica TaljaardJohannes RothRosie ScuccimarriPäivi MiettunenBianca LangAdam M. HuberKristin HoughtonJacob L. JaremkoJosephine HoNazih ShenoudaMary Ann MatzingerBrian C. LentleRobert SteinAnne Marie SbrocchiKiem OenCelia RoddRoman JuřenčákElizabeth A. CummingsRobert CouchDavid A. CabralStephanie A. AtkinsonNathalie AlosFrank RauchKerry SiminoskiLeanne M. Ward
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Abstract:
Vertebral fractures are an important yet underrecognized manifestation of osteoporosis in children with chronic, glucocorticoid-treated illnesses. Our goal was to determine the incidence and clinical predictors of vertebral fractures in the 3 years following glucocorticoid initiation among pediatric patients with rheumatic disorders. Incident vertebral fractures were evaluated according to the Genant semiquantitative method on lateral radiographs at baseline and then annually in the 3 years following glucocorticoid initiation. Extended Cox models were used to assess the association between vertebral fractures and clinical risk predictors. A total of 134 children with rheumatic disorders were enrolled in the study (mean ± standard deviation (SD) age 9.9 ± 4.4 years; 65% girls). The unadjusted vertebral fracture incidence rate was 4.4 per 100 person-years, with a 3-year incidence proportion of 12.4%. The highest annual incidence occurred in the first year (6.0%; 95% confidence interval (CI) 2.9% to 11.7%). Almost one-half of the patients with fractures were asymptomatic. Every 0.5 mg/kg increase in average daily glucocorticoid (prednisone equivalents) dose was associated with a twofold increased fracture risk (hazard ratio (HR) 2.0; 95% CI 1.1 to 3.5). Other predictors of increased vertebral fracture risk included: (1) increases in disease severity scores between baseline and 12 months; (2) increases in body mass index Z-scores in the first 6 months of each 12-month period preceding the annual fracture assessment; and (3) decreases in lumbar spine bone mineral density Z-scores in the first 6 months of glucocorticoid therapy. As such, we observed that a clinically significant number of children with rheumatic disorders developed incident vertebral fractures in the 3 years following glucocorticoid initiation. Almost one-half of the children were asymptomatic and thereby would have been undiagnosed in the absence of radiographic monitoring. In addition, discrete clinical predictors of incident vertebral fractures were evident early in the course of glucocorticoid therapy.Keywords:
Rate ratio
A self-administrated questionnaire was performed to clarify the actual circumstances of community-based screening for osteoporosis. The results revealed that only 25 percent of communities performed follow-up of high-risk participants, representing a disappointing result for assessing evidence of the benefits of measuring bone mineral density in preventing osteoporosis. Secondly, a review of the literature was performed to clarify the benefits of measuring bone mineral density in preventing osteoporosis. The review revealed that increased measurements could predict fractures among elderly and peri- and postmenopausal women, and elderly men.
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Osteoporosis is a skeletal disorder characterized by low bone mass, increased bone fragility, and susceptibility to fracture. It is of mainly into two types. Glucocorticoid induced osteoporosis occurs mainly due to the usage of glucocorticoids for prolonged periods. Glucocorticoid induced osteoporosis ranks third in importance as a risk factor for osteoporosis. It is mainly diagnosed by blood and urine estimations. The first choice of drugs for the treatment of glucocorticoid induced osteoporosis is bisphosphonates.
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Prolonged glucocorticoids administration is the most common cause of secondary osteoporosis. It is estimated that 30% to 50% of chronic glucocorticoids users experience vertebral or hip fractures. The highest bone loss (up to 30% in some
studies) is observed in the first six months of treatment. Only a minority of patients who take chronic glucocorticoids receive optimal osteoporosis diagnosis, prevention, and/or treatment. The aim of this paper is to present the pathophysiology
of glucocorticoid-induced osteoporosis, as well as some guidelines on diagnostic, preventive and therapeutic strategies for this disorder in an effort to promote the greater awareness of it.
Pathophysiology
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Glucocorticoid-induced osteoporosis is one of the most important side-effects of glucocorticoid use, leading to an increased fracture risk. In this review, recent advances in the understanding of the mechanisms of glucocorticoid-induced osteoporosis are summarised. Methods to identify persons at risk for fractures are discussed, as well as the new ACR recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis (2010). Different treatment options are summarised considering the pathogenesis of glucocorticoid-induced osteoporosis. Improved insights into pathogenesis might result in development of new treatment possibilities.
Pathogenesis
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Erythrocyte sedimentation rate
Tocilizumab
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Objective:To investigate the usage of glucocorticoid in the treatment of severe acute respiratory syndrome (SARS). Methods:Thirty cases of SARS patients' clinical data were analyzed retrospectively.Results: All thirty were given methyl prednisone or prednisone and other comprehensive treatments such as anti-infection and anti-virus.The dosages of methyl prednisone per day were 80mg to 360mg,and that of prednisone were 20mg to 30mg.SARS patients' symptoms were better controlled after two to four days treatments. But some patients' states deteriorated when the dosages of glucocorticoid were reduced too early. These patients states became stable by increasing glucocorticoid dosage and enhancing other comprehensive treatments. Conclusion: Reducing the usage of glucocorticoidinin the SAILS treatment too early may lead to the disease deteriorating.
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OBJECTIVE To understand osteoporosis and bone mineral density measurement of middle-aged and aged people in Huairou of Beijing, put forward the prevention measures. METHODS Used Metriscan dual energy X-ray absorptiometry to detect bone mineral density in 894 cases, relationship between bone mineral density measurement and T-Score score (T), the prevalence of osteoporosis. RESULTS Every 10 years as a age period, a total of five age periods, age increased while bone mineral density, T value gradually declined, there were significant differences in bone mineral density value, T value in each age group (P﹤0.05). The bone mineral density and T value in each group were different between genders (P﹤0.05). (2) In 40-49 years, 50-59 years, 60-69 years, and 70-79 years, and 80 years groups, male osteoporosis prevalence was 2.31%, 4.76%, 17.11%, 33.33%、 64.29%, and female 3.31%, 11.97%, 35.56%, 61.54%, 75.00%. Female osteoporosis prevalence was higher than male. Older than 50 years, differences in prevalence were found between genders (P﹤0.05). CONCLUSION Determination of bone density contributes to the early detection of osteoporosis, osteoporosis prevalence of elderly in Huairou the increases with increasing age. Women have lower bone density and their osteoporosis prevalence is more serious, who is the main controlled target.
Dual energy
Dual-Energy X-ray Absorptiometry
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