Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking.

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.

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).

Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.

患有肾小球疾病的儿童具有骨骼健康受损的独特危险因素。缺乏解决该人群骨骼并发症的研究。

这项回顾性队列研究利用了 PEDSnet 的数据，PEDSnet 是一个全国儿科卫生系统网络，拥有 2009 年至 2021 年间超过 650 万名患者的标准化电子健康记录数据。骨折、股骨头骨骺滑脱的发生率（每万人年）（使用泊松回归分析将 4598 名患有肾小球疾病的儿童和年轻人的 SCFE）和缺血性坏死/骨坏死（AVN）与 553,624 名普通儿科患者进行比较。使用已发表的可计算表型来识别肾小球疾病队列。一般儿科队列的纳入标准是在 1 至 21 岁之间间隔 1 年或以上进行两次或两次以上初级保健就诊，如果随访 > 3 年则每 18 个月就诊一次或多次，并且没有儿科医学定义的慢性进展性疾病复杂度算法。使用 SNOMED-CT 诊断代码识别骨折、SCFE 和 AVN；骨折需要在 48 小时内进行相关的 X 光检查或夹板/石膏固定手术。

我们发现，与一般儿科队列相比，仅女孩中肾小球疾病队列的骨折风险更高（发生率比 [IRR]，1.6；95% CI，1.3 至 1.9）。肾小球疾病队列中髋部/股骨和椎骨骨折的风险增加：调整后的 IRR 分别为 2.2（95% CI，1.3 至 3.7）和 5（95% CI，3.2 至 7.6）。对于 SCFE，调整后的 IRR 为 3.4（95% CI，1.9 至 5.9）。对于 AVN，调整后的 IRR 为 56.2（95% CI，40.7 至 77.5）。

患有肾小球疾病的儿童和年轻人的骨骼并发症负担明显高于一般儿科人群。