Department of Orthopedic Surgery, Nakadori General Hospital, Akita, Japan.
Tohoku J Exp Med. 2012 Aug;227(4):263-7. doi: 10.1620/tjem.227.263.
Vertebral fractures are an under-recognized problem in children with glucocorticoid-induced osteoporosis (GIO). They cause severe back pain and spinal column deformity with a decrease of quality of life. For evaluating the bone mass, bone mineral density measurements have been widely carried out using dual energy X-ray absorptiometry. However, bone histomorphometric analyses of GIO in children are scarce. Bone histomorphometric analyses of vertebral bodies have not been reported. Our aim is to report the first bone histomorphometric data for vertebrae from an autopsied child with GIO. A 15-year-old girl with systemic lupus erythematosus was started on a daily oral dose of 10 mg of prednisolone at 6 years of age. She presented with back pain from 12 years of age. Magnetic resonance imaging at 14 years of age showed a compression fracture of the first lumbar (L1) vertebral body. At 15 years of age, she died of heart failure owing to pulmonary hypertension. Collapsed (L1) and non-collapsed (seventh thoracic vertebrae; T7) vertebral bodies were autopsied for bone histomorphometry and compared. T7 showed severe osteoporosis (bone volume, 4.99%; trabecular thickness, 59 µm; trabecular separation, 1,134 µm). Compared with T7, L1 showed increased bone volume (33.9%) and trabecular thickness (77 µm), and decreased trabecular separation (156 µm) owing to the impact of the vertebral fracture. The bone formation and bone resorption parameters were comparable between the two vertebrae. These histological findings suggest that severe osteoporosis developed after long-term glucocorticoid administration, and that the remodeling activities were similar in the fractured and non-fractured vertebrae.
椎体骨折是儿童糖皮质激素诱导性骨质疏松症（GIO）中未被充分认识的问题。它们会导致严重的背痛和脊柱畸形，降低生活质量。为了评估骨量，广泛采用双能 X 射线吸收法进行骨矿物质密度测量。然而，儿童 GIO 的骨组织形态计量学分析却很少见。尚未报道儿童 GIO 的椎体骨组织形态计量学分析。我们的目的是报告首例 GIO 尸检儿童的椎骨骨组织形态计量学数据。一名 15 岁的系统性红斑狼疮女孩，6 岁时开始每天口服 10mg 泼尼松龙。从 12 岁开始出现背痛。14 岁时的磁共振成像显示第一腰椎（L1）椎体压缩性骨折。15 岁时，她因肺动脉高压导致心力衰竭而死亡。对塌陷的（L1）和未塌陷的（第七胸椎；T7）椎体进行尸检以进行骨组织形态计量学分析并进行比较。T7 显示严重的骨质疏松症（骨体积，4.99%；小梁厚度，59μm；小梁间隔，1134μm）。与 T7 相比，L1 由于椎体骨折的影响，骨体积（33.9%）和小梁厚度（77μm）增加，小梁间隔（156μm）减少。两个椎体的骨形成和骨吸收参数相似。这些组织学发现表明，长期糖皮质激素治疗后会发生严重的骨质疏松症，并且骨折和未骨折的椎体的重塑活动相似。
