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Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e53-e61 (doi:10.1542/peds.2007-3381)
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ARTICLE

Effect of Long-term Corticosteroid Use on Bone Mineral Density in Children: A Prospective Longitudinal Assessment in the Childhood Asthma Management Program (CAMP) Study

H. William Kelly, PharmDa, Mark L. Van Natta, MHSb, Ronina A. Covar, MDc, James Tonascia, PhDb, Rebecca P. Green, MD, PhDd, Robert C. Strunk, MDd for the CAMP Research Group

a Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
b Johns Hopkins Center for Clinical Trials, Baltimore, Maryland
c National Jewish Medical and Research Center, Denver, Colorado
d Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri

OBJECTIVE. Systemic corticosteroids are known to induce osteoporosis and increase the risk for fractures in adults and children. Inhaled corticosteroids have been shown to increase the risk for osteoporosis and fractures in adults at risk; however, long-term prospective studies of children to assess risks of multiple short courses of oral corticosteroids and chronic inhaled corticosteroids have not been performed. Thus, we assessed the effects of multiple short courses of oral corticosteroids and long-term inhaled corticosteroids on bone mineral accretion over a period of years.

METHODS. This was a cohort follow-up study for a median of 7 years of children who had mild-to-moderate asthma and initially were randomly assigned into the Childhood Asthma Management Program trial. Serial dual-energy radiograph absorptiometry scans of the lumbar spine for bone mineral density were performed for all patients. Annual bone mineral accretion was calculated for 531 boys and 346 girls who had asthma and were aged 5 to 12 years at baseline (84% of the initial cohort).

RESULTS. Oral corticosteroid bursts produced a dosage-dependent reduction in bone mineral accretion (0.052, 0.049, and 0.046 g/cm2 per year) and an increase in risk for osteopenia (10%, 14%, and 21%) for 0, 1 to 4, and ≥5 courses, respectively, in boys but not girls. Cumulative inhaled corticosteroid use was associated with a small decrease in bone mineral accretion in boys but not girls but no increased risk for osteopenia.

CONCLUSIONS. Multiple oral corticosteroid bursts over a period of years can produce a dosage-dependent reduction in bone mineral accretion and increased risk for osteopenia in children with asthma. Inhaled corticosteroid use has the potential for reducing bone mineral accretion in male children progressing through puberty, but this risk is likely to be outweighed by the ability to reduce the amount of oral corticosteroids used in these children.

Key Words: cohort study • bone mineral density • corticosteroids • asthma • children • osteopenia

Abbreviations: OCS—oral corticosteroid • BMD—bone mineral density • ICS—inhaled corticosteroid • CAMP—Childhood Asthma Management Program • DEXA—dual-energy radiograph absorptiometry

Accepted Feb 20, 2008.


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