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Effect of 2?6 weeks of systemic steroids on bone mineral density in children

Clinical and Experimental Pediatrics 2022년 65권 5호 p.254 ~ 261
Kuniyil Athira, Pal Somdipa, Sachdev Namrita, Yadav Tribhuvan Pal,
소속 상세정보
 ( Kuniyil Athira ) - Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital Department of Pediatrics
 ( Pal Somdipa ) - Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital Department of Pediatrics
 ( Sachdev Namrita ) - Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital Department of Radiodiagnosis
 ( Yadav Tribhuvan Pal ) - Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital Department of Pediatrics

Abstract


Background: The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown.

Purpose: To determine the effect of the use of systemic steroids for 2?6 weeks on BMD and BMC in pediatric patients.

Methods: Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2?6 weeks and 25 age- and sexmatched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction.

Results: Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose.

Conclusion: The use of systemic steroids for 2?6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.

키워드

Systemic steroids; Bone mineral density; Bone mineral content; Z score

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