Skeletal Outcomes in Children and Young Adults with Glomerular Disease

Amy J. Goodwin Davies, Rui Xiao, Hanieh Razzaghi, L. Charles Bailey, Levon Utidjian, Caroline Gluck, Daniel Eckrich, Bradley P. Dixon, Sara J. Deakyne Davies, Joseph T. Flynn, Daksha Ranade, William E. Smoyer, Melody Kitzmiller, Vikas R. Dharnidharka, Brianna Magnusen, Mark Mitsnefes, Michael Somers, Donna J. Claes, Evanette K. Burrows, Ingrid Y. LunaSusan L. Furth, Christopher B. Forrest, Michelle R. Denburg

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking. Methods This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours. Results We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5). Conclusions Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.

Original languageEnglish
Pages (from-to)2233-2246
Number of pages14
JournalJournal of the American Society of Nephrology
Volume33
Issue number12
DOIs
StatePublished - Dec 2022

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