Vertebral body reshaping after fractures: an important index of recovery in glucocorticoid-treated children.

In this 6-year study we identified factors associated with spontaneous vertebral body reshaping in glucocorticoid (GC)-treated children with leukemia, rheumatic disorders, and nephrotic syndrome. Subjects were 79 children (mean age 7.4 years) who had VF evaluation on lateral spine radiographs at least one year after VF detection. VF were graded using the modified Genant semi-quantitative method and fracture burden for individuals was quantified using the spinal deformity index (SDI; sum of grades from T4 to L4). Sixty-five children (82.3%) underwent complete vertebral body reshaping (median time from VF detection to complete reshaping 1.3 years by Cox proportional hazard modeling). Of 237 VF, the majority (83.1%) ultimately reshaped, with 87.2% reshaping in the thoracic region versus 70.7% in the lumbar region (p=0.004). Cox models showed that: (1) every g/m2 increase in GC exposure in the first year after VF detection was associated with a 19% decline in the probability of reshaping; (2) each unit increase in the SDI at the time of VF detection was associated with a 19% decline in the probability of reshaping (hazard ratio [HR]=0.81; 95% confidence interval [CI]=0.71, 0.92; p=0.001); (3) each additional VF present at the time of VF detection reduced reshaping by 25% (HR=0.75; 95% CI=0.62, 0.90; p=0.002); and (4) each higher grade of VF severity decreased reshaping by 65% (HR=0.35; 95% CI=0.21, 0.57; p<0.001). After experiencing a VF, children with higher GC exposure, higher SDI, more severe fractures, or lumbar VF were at increased risk for persistent vertebral deformity.

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