Effects of 3 to 6 months of systemic glucocorticoids on bone mineral density in children

Introduction: Studies on the effects of systemic steroids on bone mineral density (BMD) in children have shown conflicting results.

Objectives: To measure the effect of 3-6 months of systemic glucocorticoids on BMD in children.

Method: Thirty cases (20 nephrotic syndrome, 7 systemic lupus erythematosus and 3 juvenile dermatomyositis) and 30 age and sex matched controls were recruited. Dual Energy X-Ray Absorptiometry of whole body (WB), lumbar spine (LS) and non-dominant distal radius (DR) were done at baseline and at the end of steroid therapy for cases and controls. Total body less head (TBLH) values were derived from WB values.  For analysis, age and sex adjusted values of bone densitometric parameters were used. Student t-test or Mann-Whitney U-test was used to compare baseline data and paired t-test or Wilcoxon signed-rank test to compare patient data. Correlations were determined by Pearson and Spearman correlation coefficients. p <0.05 was taken as significant.

Results: Mean cumulative dose and duration of steroids were 217.99mg/kg and 124.23 days respectively. After steroid therapy, bone mineral content (BMC) of WB, TBLH, LS and DR decreased by 8.9%, 6.3%, 6% and 8.4% respectively whereas BMD decreased by 18%, 9.8%, 12% and 3.3% respectively. The decrease was statistically significant for BMD WB (p=0.005), DR (p=0.004) and LS (p=0.001) as well as Z scores WB (p=0.008) and LS (p=0.014). Negative correlation of Z score LS with duration of treatment and BMD WB, DR, Z score LS and BMC TBLH with cumulative dose of steroids were seen.

Conclusions: The present study revealed that 3-6 months of steroid use adversely affects both the cortical and trabecular bone.