PURPOSE OF THE STUDY.
The goal of this study was to evaluate the association between inhaled corticosteroid (ICS) use and bone mineral density (BMD) in school-age children with a history of early childhood wheezing.
This study cohort included 89 children who were part of a larger, prospectively followed group who had been hospitalized for infection-induced wheezing at <24 months of age. Exclusion criteria included prematurity and chronic lung or heart disease.
At the follow-up visit 12 years after hospitalization, corticosteroid use was assessed by patient-completed questionnaires and retrospective chart review. Cumulative doses of ICS use (converted to budesonide equivalents) and duration of ICS treatment were analyzed in 2 groups: 0 to 6 years and 6 to 12.3 years. Regular use was defined as >6 months of ICS use during the 6-year age period. Cumulative systemic corticosteroid use was calculated, and BMD was assessed by bone densitometry measurements of the lumbar spine (L2–4) and femoral neck region.
The study group included 65 boys and 24 girls. These children had an asthma prevalence of 40.2% at 7.3 years and 39.5% at 12.3 years of age. There were no significant differences in BMD among obese, overweight, and normal-weight children. Cumulative systemic corticosteroid use was not associated with BMD. In contrast, increasing cumulative ICS dosing was weakly associated with decreasing BMD in the femoral neck but not in the lumbar spine. Regular ICS use from only 0 to 6 years of age was significantly associated with lower BMD in the lumbar spine compared with children who had never used ICS. There was no difference in BMD between children who had regularly used ICS from 6 to 12.3 years of age and those who never received ICS.
Regular use of ICS before 6 years of age was associated with reduced lumbar spine BMD later in childhood, whereas high cumulative doses of ICS in childhood were associated with decreased BMD in the femoral neck.
Differences in BMD between children who were or were not treated with ICS have not been consistently reported to date. This study suggests that long-term and/or high-dose ICS use in young children may negatively affect BMD. The follow-up period in this study was longer than in other studies, but limitations include recall bias and failure to account for other lifestyle factors that may affect BMD. Also, the use of steroid-equivalents as the index of cumulative steroid use limits the generalizability of this study. Because the clinical implications of the decreased BMD are unclear, additional long-term studies are needed. However, this study underscores the importance of judicious use of ICS in young children.
- Copyright © 2015 by the American Academy of Pediatrics