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Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Ma, J., Siminoski, K., Alos, N., Halton, J., Ho, J., Cummings, E. A., Shenouda, N., Matzinger, M., Lentle, B., Jaremko, J. L., Wilson, B., Stephure, D., Stein, R., Sbrocchi, A., Rodd, C., Lewis, V. A., Laverdiere, C., Israels, S., Grant, R. M., Fernandez, C., Dix, D. B., Couch, R., Cairney, E., Barr, R., Atkinson, S., Abish, S., Moher, D., Rauch, F., Ward, L. M., Kloiber, R., Lewis, V., Midgley, J., Miettunen, P., Lentle, B. C., Blydt-Hansen, T., Cabral, D., Houghton, K., Nadel, H. R., Hay, J., Feber, J., Jurencak, R., Ma, J., Matzinger, M., Roth, J., Watanabe-Duffy, K., Clarson, C., Filler, G., Grimmer, J., McKillop, S., Sparrow, K., Huber, A. M., Lang, B., O'Brien, K., Arora, S., Dent, P. B., Coblentz, C., Larche, M., Bell, L., LeBlanc, C., Scuccimarri, R., Dubois, J., Phan, V., Saint-Cyr, C., Ellsworth, J., Jaremko, J., Grant, R., Charron, M., Hebert, D., Gaboury, I., Oen, K., Pinsk, M., Reed, M., Taback, S., Canadian STOPP Consortium 2019; 104 (2): 213–22

Abstract

To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL).Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status.Baseline height z score ± SD was 0.3 ± 1.2. It fell by 0.5 ± 0.4 in the first 6 months for boys and by 0.4 ± 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P = 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m2 increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01).GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.

View details for DOI 10.1210/jc.2018-01083

View details for Web of Science ID 000462864100001

View details for PubMedID 30247635

View details for PubMedCentralID PMC6291659