Effect of 6-12 Weeks of Systemic Glucocorticoids on Bone Mineral Density in Children

Abstract

Introduction: Prolonged use of systemic steroids in children is associated with many side-effects including effect on Bone Mineral Density (BMD). Effect of more than three months of systemic steroids on BMD has been studied in children but not the effect of 6-12 weeks duration of steroid. Aim: To evaluate the effect of 6-12 weeks of systemic glucocorticoids on BMD in children. Materials and Methods: A longitudinal observational study was conducted at a Tertiary Care Hospital. Dual Energy X-ray Absorptiometry (DEXA) of Whole Body (WB), Lumbar Spine (LS) and Distal Radius (DR) were done at baseline, end of steroid therapy or third month whichever was earlier and end of six months, on 30 patients receiving systemic steroid (Nephrotic Syndrome (NS)-7, Systemic Onset Juvenile Idiopathic Arthritis (SOJIA)-12, Tubercular Meningitis-11). Age and sex adjusted values of Bone Mineral Content (BMC), BMD and Z scores were analysed. Bone densitometric parameters of Total Body Less the Head (TBLH) were derived from WB values. X-rays of whole spine (antero-posterior and lateral view) were done at baseline and follow-up. Equal number of age and sex matched healthy controls were subjected to biochemical and DEXA scans at baseline. Continuous and categorical variables were compared using Student’s t-test and Fisher-exact test, respectively. Pairwise comparison over period of time was done using Bonferroni correction. Results: Bone densitometric parameters of cases and controls were comparable at baseline. At follow-up statistically significant decrease in BMD was found at all three sites. A statistically significant negative correlation was found between cumulative dose of steroid and duration of steroid treatment with Z score of TBLH. No vertebral fractures were detected at baseline or follow-up. Conclusion: Use of systemic glucocorticoids for 6-12 weeks negatively affects bone mineralisation, not only during therapy but even three months after stopping it.