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Emanuel Sávio Cavalcanti Sarinho, Verônica Maria Pinho Pessoa Melo
OBJECTIVE: To describe mechanisms by which glucocorticoids cause osteoporosis, with fracture risk, combining this learning with a possible professional behavior change. DATA SOURCES: A systematic search on SciELO, PubMed, Scopus, and Medline databases was carried out for consensus, review articles, including systematic reviews and meta-analysis, which were published in English, between 2000 and 2016. Keywords used on the search were the following: glucocorticoids, fractures, osteoporosis, bone health, vitamin D, children, and adolescents...
April 2017: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
Maria Luisa Bianchi
Secondary osteoporosis is increasingly observed in both adult and pediatric patients affected by many heterogeneous diseases. Most forms of secondary osteoporosis derive from one or more of the following causes: malnutrition, malabsorption, immobilization and/or reduced mechanical load, vitamin D deficiency, chronic inflammation, hormonal derangements, and chronic use of glucocorticoids and other drugs. Considering the lack of symptoms in the early phases, both the risk and the presence of secondary osteoporosis tend to be underestimated, and as a consequence, appropriate prevention/treatment measures are often delayed or not taken at all...
June 2013: Pediatric Endocrinology Reviews: PER
Outi Mäkitie
Osteoporosis, a skeletal disorder characterized by compromised bone strength and an increased risk of fractures, is an important paediatric disorder that involves almost all paediatric subspecialties. Osteogenesis imperfecta is the most common form of childhood-onset primary osteoporosis, but several other forms are also known. Secondary osteoporosis is caused by an underlying chronic illness or its treatment. The most common causes of secondary osteoporosis include chronic systemic inflammation, glucocorticoid use and neuromuscular disabilities...
August 2013: Nature Reviews. Rheumatology
Annamaria Ventura, Giacomina Brunetti, Silvia Colucci, Angela Oranger, Filomena Ladisa, Luciano Cavallo, Maria Grano, Maria Felicia Faienza
21-Hydroxylase deficiency (21-OHD) is the most common cause of congenital adrenal hyperplasia (CAH), resulting from deletions or mutations of the P450 21-hydroxylase gene (CYP21A2). Children with 21-OHD need chronic glucocorticoid (cGC) therapy, both to replace congenital deficit in cortisol synthesis and to reduce androgen secretion by adrenal cortex. GC-induced osteoporosis (GIO) is the most common form of secondary osteoporosis that results in an early, transient increase in bone resorption accompanied by a decrease in bone formation, maintained for the duration of GC therapy...
2013: BioMed Research International
Yuji Hatakeyama, Naohisa Miyakoshi, Yuji Kasukawa, Arata Watanabe, Masashi Hirayama, Seietsu Senma, Iwao Ono, Yoichi Shimada
Vertebral fractures are an under-recognized problem in children with glucocorticoid-induced osteoporosis (GIO). They cause severe back pain and spinal column deformity with a decrease of quality of life. For evaluating the bone mass, bone mineral density measurements have been widely carried out using dual energy X-ray absorptiometry. However, bone histomorphometric analyses of GIO in children are scarce. Bone histomorphometric analyses of vertebral bodies have not been reported. Our aim is to report the first bone histomorphometric data for vertebrae from an autopsied child with GIO...
August 2012: Tohoku Journal of Experimental Medicine
Nathalie Alos, Ronald M Grant, Timothy Ramsay, Jacqueline Halton, Elizabeth A Cummings, Paivi M Miettunen, Sharon Abish, Stephanie Atkinson, Ronald Barr, David A Cabral, Elizabeth Cairney, Robert Couch, David B Dix, Conrad V Fernandez, John Hay, Sara Israels, Caroline Laverdière, Brian Lentle, Victor Lewis, MaryAnn Matzinger, Celia Rodd, Nazih Shenouda, Robert Stein, David Stephure, Shayne Taback, Beverly Wilson, Kathryn Williams, Frank Rauch, Kerry Siminoski, Leanne M Ward
PURPOSE: Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. PATIENT AND METHODS: We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semiquantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures...
August 1, 2012: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
A M Sbrocchi, F Rauch, P Jacob, A McCormick, H J McMillan, M A Matzinger, L M Ward
UNLABELLED: The impact of intravenous bisphosphonate treatment to treat painful vertebral fractures in boys with DMD has not been documented. In this retrospective observational study of seven boys, 2 years of intravenous bisphosphonate therapy was associated with back pain improvement and stabilization or increases in the height ratios of fractured vertebrae. INTRODUCTION: Boys with Duchenne muscular dystrophy (DMD) are at risk for vertebral fractures. We studied the impact of intravenous bisphosphonate therapy for the treatment of painful vertebral fractures in DMD...
November 2012: Osteoporosis International
Celia Rodd, Bianca Lang, Timothy Ramsay, Nathalie Alos, Adam M Huber, David A Cabral, Rosie Scuccimarri, Paivi M Miettunen, Johannes Roth, Stephanie A Atkinson, Robert Couch, Elizabeth A Cummings, Peter B Dent, Janet Ellsworth, John Hay, Kristin Houghton, Roman Jurencak, Maggie Larché, Claire LeBlanc, Kiem Oen, Claire Saint-Cyr, Robert Stein, David Stephure, Shayne Taback, Brian Lentle, Maryann Matzinger, Nazih Shenouda, David Moher, Frank Rauch, Kerry Siminoski, Leanne M Ward
OBJECTIVE: To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk. METHODS: Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z scores, were analyzed for association with IVF...
January 2012: Arthritis Care & Research
K Siminoski, K-C Lee, H Jen, R Warshawski, M A Matzinger, N Shenouda, M Charron, C Coblentz, J Dubois, R Kloiber, H Nadel, K O'Brien, M Reed, K Sparrow, C Webber, B Lentle, L M Ward
SUMMARY: We compared the distribution of vertebral fractures in adults and children and found that fractures occurred in different locations in the two age groups. This likely relates to the different shape of the immature spine. INTRODUCTION: We hypothesized that the anatomical distribution of vertebral fractures (VF) would be different in children compared to adults. METHODS: We compared the distribution of VF defined using the Genant semi-quantitative method (GSQ method) in adults (N = 221; 545 fractures) and in children early in the course of glucocorticoid therapy (N = 44; 94 fractures)...
July 2012: Osteoporosis International
Susanne Bechtold, Stefanie Putzker, Julia Birnbaum, Hans-Peter Schwarz, Heinrich Netz, Robert Dalla Pozza
BACKGROUND: Impaired bone health has been advocated after solid organ transplantation in adult and pediatric patients. Osteoporosis accompanied by fractures have been found also in heart transplantation recipients. METHODS: Parameters of bone mineral density (BMD) and bone geometry were measured in 34 patients (15 females, mean age: 14.6 ± 5.5 years) 5.28 ± 5.16 years after heart transplantation (n=30) and heart-lung transplantation (n=4) using peripheral quantitative computed tomography...
November 15, 2010: Transplantation
S Lekamwasam
OBJECTIVE: To find out the proportion of patients who qualifies to receive prophylactic therapy for glucocorticoid-induced osteoporosis. DESIGN: Retrospective record review. Participants Current users of oral glucocorticoids referred for bone mineral density estimation to assess their fracture risk (n=134). MEASUREMENTS: Clinical history and bone mineral density of the spine and proximal femur. RESULTS: Based on the current U...
June 2010: Ceylon Medical Journal
A M Huber, I Gaboury, D A Cabral, B Lang, A Ni, D Stephure, S Taback, P Dent, J Ellsworth, C LeBlanc, C Saint-Cyr, R Scuccimarri, J Hay, B Lentle, M Matzinger, N Shenouda, D Moher, F Rauch, K Siminoski, L M Ward
OBJECTIVE: Vertebral fractures are an under-recognized problem in children with inflammatory disorders. We studied spine health among 134 children (87 girls) with rheumatic conditions (median age 10 years) within 30 days of initiating glucocorticoid therapy. METHODS: Children were categorized as follows: juvenile dermatomyositis (n = 30), juvenile idiopathic arthritis (n = 28), systemic lupus erythematosus and related conditions (n = 26), systemic arthritis (n = 22), systemic vasculitis (n = 16), and other conditions (n = 12)...
April 2010: Arthritis Care & Research
Chiara S M Straathof, W C G Truus Overweg-Plandsoen, Gert Jan van den Burg, Anneke J van der Kooi, Jan J G M Verschuuren, Imelda J M de Groot
Corticosteroids are effective in improving motor function in Duchenne muscular dystrophy (DMD) patients within 6 months-2 years of treatment initiation, but there is as yet no consensus on which treatment scheme is the best. We retrospectively analyzed data of 35 DMD patients who were treated with prednisone 0.75 mg/kg per day intermittently 10 days on/10 days off. Prednisone was started during the ambulant phase at age 3.5-9.7 years (median 6.5 years). The median period of treatment was 27 months (range 3-123 months)...
May 2009: Journal of Neurology
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
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 BMD and other clinical indices, have not been systematically studied. We evaluated spine health in 186 newly diagnosed children (median age, 5.3 yr; 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...
July 2009: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
L Ward, A C Tricco, P Phuong, A Cranney, N Barrowman, I Gaboury, F Rauch, P Tugwell, D Moher
BACKGROUND: Children with chronic illnesses are at increased risk for reductions in bone strength and subsequent fractures (osteoporosis), either due to the impact of the underlying condition on skeletal development or due to the osteotoxic effect of medications (e.g., glucocorticoids) used to treat the chronic illness. Bisphosphonates are being administered with increasing frequency to children with secondary osteoporosis; however, the efficacy and harm of these agents remains unclear...
2007: Cochrane Database of Systematic Reviews
Ann-Charlott Söderpalm, Per Magnusson, Anne-Christine Ahlander, Jón Karlsson, Anna-Karin Kroksmark, Már Tulinius, Diana Swolin-Eide
This cross-sectional study examined bone mineral density, bone turnover, body composition and calciotropic hormones in 24 boys with Duchenne muscular dystrophy (DMD) (2.3-19.7 years), most of whom were being treated with prednisolone, and 24 age-matched healthy boys. Our study demonstrated lower bone mineral density in the DMD group for total body, spine, hip, heel and forearm measurements. These differences between DMD patients and controls increased with increasing age. Biochemical markers of both bone formation and resorption revealed reduced bone turnover in DMD patients...
December 2007: Neuromuscular Disorders: NMD
Helena Valta, Pekka Lahdenne, Hannu Jalanko, Kristiina Aalto, Outi Mäkitie
OBJECTIVE: To evaluate bone health and growth and their correlates in glucocorticoid (GC)-treated pediatric patients with juvenile idiopathic arthritis (JIA). METHODS: Consecutive patients with a history of JIA for >or= 2 years and systemic GC treatment for >or= 3 months were assessed for bone health and its determinants. Areal bone mineral density (aBMD) and vertebral body morphology were assessed with DEXA; Z scores were adjusted for calendar and bone age...
April 2007: Journal of Rheumatology
Laura Quarta, Addolorata Corrado, Nadia Melillo, Francesco Paolo Cantatore
Juvenile idiopathic arthritis represents a heterogeneous group of autoimmune diseases. It arises before 16 years of age and lasts more than 6 months. We can distinguish many arthritis sub-types. A serious problem in juvenile idiopathic arthritis is skeletal growth retardation, osteopenia and greater risk of developing fractures. Juvenile idiopathic arthritis diagnosis is an exclusion diagnosis. Many conditions can simulate it. First-choice drugs in juvenile idiopathic arthritis treatment are nonsteroidal anti-inflammatory drugs, analgesic and antipyretic drugs...
October 2005: Annali Italiani di Medicina Interna: Organo Ufficiale Della Società Italiana di Medicina Interna
Jari Peltonen, Ville Remes, Christer Holmberg, Hannu Jalanko, Ilkka Helenius
A review of the current literature reveals no systematic analyses of the results of surgical correction of spinal deformity after pediatric organ transplantation. We therefore evaluated clinical and radiographic outcomes of spinal deformity correction after solid organ transplantation in childhood and adolescence. All 211 cases of heart, liver, and kidney transplantations performed in children in our country were reviewed. Six patients had undergone surgical correction of spinal deformity at a mean age 14.6 (range 12-17) years...
August 2006: European Spine Journal
F Rossi, S Perrotta, E Falcone, F Gimigliano, M Iodice, S Vetrella, G Iolascon
Osteoporosis is a common disease characterized by reduced bone mass, with a consequent increase in bone fragility and susceptibility to fracture risk. Bone mineral density (BMD) measurement is used to make the diagnosis of osteoporosis prior to incident fracture, and to predict fracture risk. BMD is determined by the peak bone mass achieved, and the rate and timing of subsequent bone loss. Dual-energy X-ray absorptiometry (DEXA) is the most popular and effective method utilized for osteoporosis screening. Bone disease is a side effect of concern regarding chronic glucocorticoid (GC) administration...
October 2005: Minerva Pediatrica
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