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Children on steroids more likely to suffer bone fractures, study finds

OC3.2 (2013)

May 22, 2013, Lisbon, Portugal. Press Dispensary. A recent study of Canadian children who are being treated with steroids for illnesses such as leukaemia and rheumatic conditions shows that they have a high likelihood of suffering bone fractures while they're being treated with steroids. During the three years of steroid treatment, a quarter of all children in the study had at least one fracture.

The results of the study were presented at the 50th anniversary congress of the European Calcified Tissue Society (ECTS), being held in Lisbon, Portugal, on May 18-21, 2013.

404 children from across Canada took part in the study. They were aged between one and 17 years; 50% of them were boys and they were studied annually over a three year period, with the study starting within 18 days of them taking their initial steroid dose. 188 of the children had leukaemia, 136 rheumatic conditions and 80 had nephrotic syndrome.

children who are being treated with steroids over several years can have an unusually high likelihood of a bone fracture in that time
Dr Leanne Ward

25% of children suffered at least one fracture in the three years and 18% had incident fractures. 41% of the fractures were moderate or severe.

Leanne M Ward MD, of the Children's Hospital of Eastern Ontario, who presented the findings to the ECTS Congress, said: "The number of children who suffered fractures was high: 18% of children with incident fractures is a high proportion, with incident fractures peaking at about one year (over the three year period).

"We also noticed a slightly higher incidence among pre-pubertal girls, and, as you'd expect, children with a lower bone mineral density or BMD. Our conclusion is that children who are being treated with steroids over several years can have an unusually high likelihood of a bone fracture in that time, with most of the bone morbidity occurring within the first 12 months of steroid therapy."

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Notes for editors
The European Calcified Tissue Society (ECTS) is the major organisation in Europe for researchers and clinicians working in the field of calcified tissues and related fields and in 2013 is celebrating its 50th anniversary. ECTS acts as a forum for the dissemination of high quality research through its annual meeting, the European Symposium on Calcified Tissues, and through training courses and workshops.

Calcified tissues are central to a healthy skeleton and to bone disorders - such as osteoporosis, back pain and fractures - that make life a misery for countless people. Children can inherit some forms of bone diseases causing bone pain, shortness and deformed limbs.

The 50th anniversary meeting of the European Calcified Tissue Society takes place in Lisbon, Portugal, on May 18-21, 2013. Some 3,500 delegates are expected to attend.

About the study

Of the 404 children enrolled, median age was 6.2 years, range 1-17; 50% boys; 188 (46%) had leukemia, 136 (34%) rheumatic conditions, and 80 (20%) nephrotic syndrome. Initial study visit occurred within 18 days of steroid initiation (inter-quartile range 11–24 days).

Over the 3 years, 70/404 children (26%; 95% CI 21-31) had at least one prevalent fracture and 18% (95% CI 14-23) had at least one incident fracture; 41% (53/129) of fractures were moderate or severe.

While no significant time trend was observed in the proportion of children with prevalent fractures (p=0.21), the proportion with incident fractures peaked at 12 months and declined thereafter (p=0.04).

In multivariable modeling assessing baseline clinical factors, prevalent fractures at baseline (incidence Rate Ratio (RR) 6.6), female gender (RR 1.9), pre-pubertal status (RR 2.4), higher average daily Vitamin D intake (RR 2.6) and lower BMD Z-scores (RR 1.5) were associated with fracture incidence.

Fractures were assessed annually for 3 years through prospective study using the Genant method. Proportions of patients with at least one prevalent or incident fracture were determined and trends over time evaluated using Generalized Estimating Equations. The total number of new fractures over the 3-year period was analyzed using Poisson regression. Associations with clinical factors at baseline were examined using multivariable models with stepwise backward elimination (alpha=0.15).

For further information please contact
Roberta Mugnai, ECTS executive director
European Calcified Tissue Society (ECTS)
Tel: + 32 476 520 716

Media contacts

Roberta Mugnai, ECTS executive director
Tel: + 32 476 520 716

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