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Ann Pediatr Endocrinol Metab > Accepted Articles
DOI: https://doi.org/10.6065/apem.2244026.013    [Accepted] Published online June 28, 2022.
Factors affecting bone mineral density in children and adolescents with secondary osteoporosis
Min Jeong Jang  , Chungwoo Shin, Seongkoo Kim, Jae Wook Lee, Nack-Gyun Chung, Bin Cho, Min Ho Jung, Byung-Kyu Suh, Moon Bae Ahn 
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
Address for correspondence:  Moon Bae Ahn
Email: mbahn@catholic.ac.kr
Received: February 4, 2022   Revised: March 16, 2022   Accepted: March 29, 2022
This study aimed to investigate the clinical factors associated with bone mineral density (BMD) among children and adolescents with osteoporosis secondary to treatment for underlying clinical conditions.
We retrospectively reviewed the medical records of patients aged 10–18 years evaluated lumbar spine BMD (LSBMD) after treatment for underlying diseases, including hemato-oncologic, rheumatologic system, and inflammatory bowel diseases. Among them, LSBMD measured by dual-energy x-ray absorptiometry (DXA) performed from March 2019 to March 2021 was evaluated. We analyzed 117 patients who underwent the initial DXA after treatment for underlying diseases.
The percentage of underlying diseases of subjects in this study is as follows: hemato-oncologic (78.6%), rheumatologic (11.1%) and inflammatory bowel diseases (10.3%). There was no significant association between the Z-score and bone metabolic markers (p>0.05). However, the higher cumulative glucocorticoid (GC) dose significantly reduced LSBMD z-score (p=0.029). Moreover, the association between the cumulative dose of GC and initial Z-scores of LSBMD was statistically significant in the logarithmic regression analysis (p=0.003, R2=0.149). Glucocorticoid accumulation also was a significant risk factor for vertebral fracture when the initial BMD was evaluated after treatment (p=0.043). Bone metabolic markers did not significantly influence the risk of vertebral fracture.
The initial bone mass density of the lumbar spine evaluated after long-term glucocorticoid use for underlying diseases is a predictor of further vertebral fractures.
Keywords: Secondary osteoporosis, Bone mineral density, Dual-energy x-ray absorptiometry


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