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
Affiliations
Kebashni Thandrayen
Corresponding author at: Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, PO Bertsham, Johannesburg 2013, South Africa.; Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Udai Keshav Kala
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Nilesh Lala
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Grace Okudo
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Kiran Bhagoo Parbhoo
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Fatima Yakoub Moosa
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Charl Verwey
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Marc Hauptfleisch
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Christina Hajinicolaou
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Priya Ramanlal Ambaram
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Bhadrish Jayantkumar Mistry
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Karen Lavinia Petersen
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
John Morley Pettifor
Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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.
