Osteoporotic vertebral compression fracture in patients with childhood-onset lupus nephritis: prevalence and risk factors

IF 2.8 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Archives of Osteoporosis Pub Date : 2025-07-27 DOI:10.1007/s11657-025-01590-9

Pornpimol Rianthavorn, Kamonwan Ueapanyaporn, Supatporn Tepmongkol, Nuanpan Penboon, Noppachart Limpaphayom

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引用次数: 0

Abstract

Summary

Vertebral fractures (VF) can occur due to childhood-onset lupus nephritis (cLN), which needs long-term use of immunosuppressants that affect bone health. This study found VF in 26.7% of cLN patients. Risk factors included low lumbar spine BMD Z-scores and high disease activity (SLEDAI-2K ≥ 20). Bone-strengthening and disease management strategies are important.

Purpose

Pediatric vertebral fracture (VF) may occur under conditions that lead to decreased bone mass. Childhood-onset lupus nephritis (cLN) requires treatment with glucocorticoids and immunosuppressants. This study aimed to determine the prevalence of and risk factors for VF in patients with cLN.

Methods

Patients with cLN who received glucocorticoids for more than 12 months underwent bone mineral density (BMD) evaluation and vertebral fracture assessment (VFA) via DXA scanning. Lupus disease activity was determined with the SLE Disease Activity Index 2000 (SLEDAI-2K), and scores ≥ 20 were classified as very high. Patients were classified based on the degree of vertebral compression using the Genant grading into two groups: VF (VFA > 20%) and no VF. Logistic regression was conducted to identify risk factors for VF.

Results

Seventy-five patients (67 females, 89%) were enrolled. The average age at diagnosis was 11.5 ± 2.2 years. The mean duration of cLN was 7.9 ± 5.8 years. Twenty patients (26.7%) had VF and 11 (55%) had multiple VFs. The median VFA was 20%, with an anterior compression predominance (84%). A logistic regression model identified two risk factors: a low lumbar spine BMD Z-score (OR 0.48, 95% CI 0.25–0.89, P = 0.02) and a very high SLEDAI-2K score (OR 20.38, 95% CI 1.60–257.89, P = 0.02).

Conclusion

Multiple VFs were prevalent in patients with cLN. The risk of VF increased by 48% with a one-unit decrease in the BMD Z-score and by 20 times with a very high SLEDAI-2K score. A strategy to maintain bone strength and control disease activity should be implemented in patients with cLN.

Abstract Image

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儿童期狼疮性肾炎患者骨质疏松性椎体压缩性骨折：患病率和危险因素

儿童期狼疮性肾炎（cLN）可导致椎体骨折（VF），需要长期使用影响骨骼健康的免疫抑制剂。本研究发现26.7%的cLN患者有VF。危险因素包括腰椎BMD z -评分低和疾病活动性高（SLEDAI-2K≥20）。骨骼强化和疾病管理策略很重要。目的：小儿椎体骨折（VF）可能发生在导致骨量减少的情况下。儿童期狼疮性肾炎（cLN）需要糖皮质激素和免疫抑制剂治疗。本研究旨在确定cLN患者VF的患病率和危险因素。方法：接受糖皮质激素治疗超过12个月的cLN患者通过DXA扫描进行骨矿物质密度（BMD）评估和椎体骨折评估（VFA）。狼疮疾病活动性用SLE疾病活动性指数2000 （SLEDAI-2K）来确定，评分≥20分为非常高。根据椎体压迫程度，采用Genant分级法将患者分为两组：VF （VFA > 20%）和无VF。采用Logistic回归来确定VF的危险因素。结果：纳入75例患者（67例女性，89%）。平均诊断年龄11.5±2.2岁。cLN的平均持续时间为7.9±5.8年。20例（26.7%）有室性颤动，11例（55%）有多发室性颤动。中位VFA为20%，前压迫为主（84%）。logistic回归模型确定了两个危险因素：低腰椎BMD z -评分（OR 0.48, 95% CI 0.25-0.89, P = 0.02）和非常高的SLEDAI-2K评分（OR 20.38, 95% CI 1.60-257.89, P = 0.02）。结论：cLN患者多发室间隔多见。当BMD z -评分降低1个单位时，VF的风险增加48%；当SLEDAI-2K评分非常高时，VF的风险增加20倍。cLN患者应采取维持骨强度和控制疾病活动性的策略。

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来源期刊

Archives of Osteoporosis ENDOCRINOLOGY & METABOLISMORTHOPEDICS -ORTHOPEDICS

CiteScore

5.50

自引率

10.00%

发文量

133

期刊介绍： Archives of Osteoporosis is an international multidisciplinary journal which is a joint initiative of the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA. The journal will highlight the specificities of different regions around the world concerning epidemiology, reference values for bone density and bone metabolism, as well as clinical aspects of osteoporosis and other bone diseases.