Advanced Vertebral Fracture Among Newly Diagnosed Children With Acute Lymphoblastic Leukemia: Results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) Research Program
| Autor: | Jacqueline, Halton, Isabelle, Gaboury, Ronald, Grant, Nathalie, Alos, Elizabeth A, Cummings, Maryann, Matzinger, Nazih, Shenouda, Brian, Lentle, Sharon, Abish, Stephanie, Atkinson, Elizabeth, Cairney, David, Dix, Sara, Israels, David, Stephure, Beverly, Wilson, John, Hay, David, Moher, Frank, Rauch, Kerry, Siminoski, Leanne M, Ward, Martin, Reed |
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| Rok vydání: | 2009 |
| Předmět: |
Male
musculoskeletal diseases Canada medicine.medical_specialty Adolescent Bone density Childhood leukemia Endocrinology Diabetes and Metabolism Osteoporosis Lumbar vertebrae Thoracic Vertebrae Article Bone Density Internal medicine Prevalence medicine Back pain Humans Orthopedics and Sports Medicine Child Glucocorticoids Bone growth Lumbar Vertebrae business.industry Infant Newborn Infant Bone age Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Surgery medicine.anatomical_structure Child Preschool Thoracic vertebrae Spinal Fractures Female medicine.symptom business |
| Zdroj: | Journal of Bone and Mineral Research. 24:1326-1334 |
| ISSN: | 0884-0431 |
| DOI: | 10.1359/jbmr.090202 |
| Popis: | Vertebral compression is a serious complication of childhood acute lymphoblastic leukemia (ALL). The prevalence and pattern of vertebral fractures, as well as their relationship to bone mineral density (BMD) and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age 5.3 years, 108 boys) with ALL (precursor B cell: N=167; T-cell: N=19), who were enrolled in a national bone health research program. Patients were assessed within 30 days of diagnosis by lateral thoraco-lumbar spine radiograph, bone age (also used for metacarpal morphometry) and BMD. Vertebral morphometry was carried out by the Genant semi-quantitative method. Twenty-nine patients (16%) had a total of 75 grade 1 or higher prevalent vertebral compression fractures (53 thoracic, 71%; 22 lumbar). Grade 1 fractures as the worst grade were present in 14 children (48%), 9 patients (31%) had grade 2 fractures, and 6 children (21%) had grade 3 fractures. The distribution of spine fracture was bi-modal, with most occurring in the mid-thoracic and thoraco-lumbar regions. Children with grade 1 or higher vertebral compression had reduced lumbar spine (LS) areal BMD Z-scores compared to those without (mean±SD, −2.1±1.5 vs. −1.1±1.2; P < 0.001). LS BMD Z-score, second metacarpal percent cortical area Z-score, and back pain were associated with increased odds for fracture. For every 1 SD reduction in LS BMD Z-score, the odds for fracture increased by 80% (95% CI 10% to 193%); the presence of back pain had an odds ratio of 4.7 (95% CI, 1.5 to 14.5). These results show that vertebral compression is an under-recognized complication of newly diagnosed ALL. Whether the fractures will resolve through bone growth during or after leukemia chemotherapy remains to be determined. |
| Databáze: | OpenAIRE |
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