The impact of long-term corticotherapy on bone health in children with idiopathic nephrotic syndrome

Česká verzia

Authors: K. Kubejová ¹; L. Turoňová ²; V. Vargová ¹; M. Čaprnda ³; G. Koľvek ¹; Ľ. Podracká ⁴
Authors place of work: Klinika detí a dorastu LF UPJŠ a DFN Košice, Slovensko ¹; Klinika detí a dorastu JLF UK a UNM, Martin, Slovensko ²; 1. interná klinika LFUK a UNB, Bratislava, Slovensko ³; Detská klinika (DK) LF UK a NÚDCH, Bratislava, Slovensko ⁴
Published in the journal: Čes-slov Pediat 2019; 74 (4): 224-232.
Category: Original Papers

Summary

Objective: The aim of the study was to assess the impact of prolonged corticotherapy on growth, bone metabolism and bone mineral density (BMD) parameters in children with idiopathic nephrotic syndrome (INS).

Methods: 39 patients with INS (24 boys, mean age 11.09±4.29 years) and 40 healthy controls of comparable age and gender were enrolled in the study. In the INS group, the mean daily dose of prednisone was 0.70±0.24 mg/kg/day (mean cumulative corticosteroid dose 367.13±268.45 mg/kg, mean duration of corticosteroid treatment was 551.15±343.10 days). The effect of corticotherapy on bone health was assessed by 1) anthropometric measurements 2) bone metabolism testing, taking into account laboratory deviations specific to INS 3) DXA (dual-energy X-ray absorptiometry).

Results: Compared with the control group of healthy children, we observed a significantly lower Z-score of body height (-0.81±1.34 vs 0.32±0.87; p<0.001) in the INS group, which correlated negatively with the cumulative dose of corticoids (p=0.03) and the length of corticotherapy (p=0.025). Patients taking prednisone at the time of measurement had a more pronounced decrease in body height Z-score compared to patients without steroids (-1.26±1.34 vs -0.33±1.2; p=0.002). BMD Z-scores in L1-L4 and TBLH (total body less head) in the INS group were also significantly lower compared to the control group (-0.29±1.30 vs 0.70±1.10; p˂0.001, 0.10±1.15 vs 0.99±1.10; p=0.001). In patients receiving corticoids, we found a statistically significant decrease in BMD Z-score of L1-L4 and TBLH compared with patients free of steroids (L1-L4: p=0.001; TBLH: p=0.003). BMD Z-score significantly correlated with the cumulative corticosteroid dose (L1-L4: p˂0.001, TBLH: p=0.002) and correlated with the length of corticotherapy (L1-L4: p=0.006; TBLH: p=0.043). We did not confirm statistically significant differences in serum concentrations of 25-OH-D, ALP, iPTH, calcium and phosphorus depending on the cumulative corticosteroid dose or the duration of corticosteroid therapy.

Conlusion: Linear growth and BMD Z-scores in the L1-L4 and TBLH regions are during long-term corticosteroid treatment in the comparison to the healthy control group significantly reduced and negatively correlate with the cumulative corticosteroid dose and the length of corticotherapy. The role of a first contact pediatrician (during the long-term corticotherapy) is to monitor the clinical and laboratory indicators (in cooperation with a specialist) of corticoid-induced bone damage and to monitor the effectiveness of preventive regimens.

Keywords:

idiopathic nephrotic syndrome – linear growth – DXA – aBMD

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