Bone mass and vertebral fractures in South African children on prolonged oral glucocorticoids for chronic non-malignant illnesses

Kebashni Thandrayen; Udai Keshav Kala; Nilesh Lala; Grace Okudo; Kiran Bhagoo Parbhoo; Fatima Yakoub Moosa; Charl Verwey; Marc Hauptfleisch; Christina Hajinicolaou; Priya Ramanlal Ambaram; Bhadrish Jayantkumar Mistry; Karen Lavinia Petersen; John Morley Pettifor

doi:10.1016/j.bonr.2021.100751

Bone mass and vertebral fractures in South African children on prolonged oral glucocorticoids for chronic non-malignant illnesses

Bone Rep. 2021 Feb 2:14:100751. doi: 10.1016/j.bonr.2021.100751. eCollection 2021 Jun.

Authors

Kebashni Thandrayen^{1

2}, Udai Keshav Kala^{1

2}, Nilesh Lala^{1

2}, Grace Okudo^{1

2}, Kiran Bhagoo Parbhoo^{1

2}, Fatima Yakoub Moosa^{1

2}, Charl Verwey^{1

2}, Marc Hauptfleisch^{1

2}, Christina Hajinicolaou^{1

2}, Priya Ramanlal Ambaram^{1

2}, Bhadrish Jayantkumar Mistry^{1

2}, Karen Lavinia Petersen^{1

2}, John Morley Pettifor^{1

2}

Affiliations

¹ Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
² Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Introduction: We hypothesized that the prevalence of vertebral fractures would be low and that bone mineral density (BMD) would be less severely affected in a black South African (SA) population treated with glucocorticoids (GCs) than that reported in mainly white populations.

Methods: All children aged 5-17.9 years with chronic non-malignant illnesses who were on GCs (intravenous or oral) for greater than 3 months duration were evaluated. DXA scans were performed using a Hologic Discovery machine (Software version Apex 4.0.2) and the Hologic paediatric reference database. Whole body less head (WBLH) and lumbar spine (LS) bone mineral content (BMC) and density (BMD) Z-scores unadjusted and adjusted for height were calculated using the Zemel equation calculator.

Results: Seventy-two patients (49% with renal, 24% with rheumatic, 14% with neurological, 11% with hepatic and 3% with respiratory conditions; mean age 11.6 ± 3.3 years, 57% boys, 92% SA black) were enrolled. The mean duration of GC treatment was 34.1 (±25.1) months. Mean WBLH and LS height adjusted BMD Z-scores were -1.2 ± 1.5 and -0.9 ± 1.0 respectively. Eleven percent of patients had a LS height adjusted BMD Z-score ≤ -2. The prevalence of vertebral fractures on lateral vertebral fracture assessment (VFA) was 15% (11 of 72 patients).

Conclusion: The prevalence of vertebral fractures (15%) in predominantly black children on GCs with chronic non-malignant illnesses is similar to that reported from North America suggesting that routine yearly DXA scans including VFA are warranted in this highly at-risk population.

Keywords: Bone mineral density; Children; Fractures; Glucocorticoids; Osteoporosis; South Africa.