Kelly HW, Van Natta ML, Covar RA, et al. Pediatrics. 2008;122(1). Available at: www.pediatrics.org/cgi/content/full/122/1/e53
PURPOSE OF THE STUDY. To evaluate the effects of multiple short courses of oral corticosteroid treatment and longterm inhaled corticosteroid (ICS) treatment on bone mineral accretion over a period of years.
STUDY POPULATION. Cohort follow-up study for a median of 7 years with 877 children 5 to 12 years of age who had mild-to-moderate asthma and initially were randomly assigned in the Childhood Asthma Management Program.
METHODS. Serial dual-energy x-ray absorptiometry scans of the lumbar spine to assess bone mineral density were performed for all patients. Annual bone mineral accretion was calculated for 531 boys and 346 girls.
RESULTS. Oral corticosteroid bursts produced dose-dependent reductions in bone mineral accretion (0.052, 0.049, and 0.046 g/cm2 per year with 0, 1–4, and ≥5 courses, respectively) and increases in the risk for osteopenia (10%, 14%, and 21%, respectively) in boys but not girls. Cumulative ICS 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 dose-dependent reductions in bone mineral accretion and increased risk for osteopenia in children with asthma. ICS use has the potential to reduce bone mineral accretion in male children progressing through puberty, but this risk is likely to be outweighed by the ability to reduce the amounts of orally administered corticosteroids used for these children.
REVIEWERS COMMENTS. One of the goals for prescribing an ICS is to decrease the chances of acute exacerbations, which often require oral corticosteroid treatment for asthma control. The findings of this long-term treatment study highlight one of the several reasons to strive to minimize repeat doses of orally administered corticosteroid in children, especially during times of peak bone mineral accretion. Interestingly, the effects of decreased bone mineral accretion with orally administered corticosteroid and ICS were not seen for girls in this study. Girls might have been less susceptible because of estrogen effects and/or being on the flat portion of their bone mineral accretion curve during the study period, but this topic will require additional study. The finding of no increased risk for osteopenia with regular use of ICS is somewhat reassuring, although most of the children in this study were receiving low doses of ICS, and additional studies with children receiving medium or high doses ICS are warranted.
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