Bone Mass And Vertebral Fractures In South African Children On Prolonged Oral Glucocorticoids For Chronic Non-Malignant Illnesses

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 glucocor-ticoids (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.