BONE MINERAL DENSITY PROFILE IN CHILDREN RECEIVING CORTICOSTEROIDS FOR RENAL INDICATIONS FOR MORE THAN TWELVE WEEKS

Introduction:

Corticosteroids form the basis of treatment of many childhood kidney diseases; most commonly used in childhood nephrotic syndrome.Steroids can cause osteoporosis in children and have a negative impact on bone mineral content (BMC) and bone mineral density (BMD).This study analyses the relation between steroid exposure and BMD changes in paediatric population as compared to those not on steroids.   

Methods:

 This clinical trial was conducted between February-October 2024 and is funded by an academic grant. 25 children who are on steroids for renal indications and 25 children without history of steroid usage were recruited and underwent BMD DEXA Scan and metabolic work up for bone health. Inclusion criteria: Children aged 5-18 years and on steroids for more than twelve weeks for renal indications with an eGFR of >90 ml/min/1.73m2 were included in the steroid arm and those without steroid use were included in the control arm.. Children with prior bone disease and those whose parents refused consent were excluded. History including dose and duration of steroid intake,calcium intake (diet and medication) and outdoor activity was noted. Clinical examination with special focus on growth assessment, vital signs, edema, & ascites . Serum creatinine, serum albumin, serum calcium and phosphorus, alkaline phosphatase levels, serum vitamin D3 levels and intact parathyroid hormone (PTH) were measured in the study population. BMD DEXA scan was performed with GE lunar prodigy advance apparatus and Z scores of Total Body Less Head (TBLH) and Antero-Posterior(AP) Spine noted and compared to reference ranges of USA NHANES data for pediatric population. TBLH value was computed only for children >7years of age for lack of reference data in under seven years population   

Results:

Twenty five children on steroids and twenty five children not on steroids underwent blood analysis and BMD- DEXA scan. In the steroid arm- fourteen were girl children and fifteen were in the prepubertal stage. All children met the daily recommended calcium intake. 18 children were on steroids for nephrotic syndrome, 4 for lupus nephritis and 1 each for Takayasu arteritis,atypical HUS and C3GN. Out of the 25, only 9 children had a height less than 3rd centile. Serum Vitamin D was low (<30 IU) in 14 children.Bone density assessed by AP spine Z score was low in 84% (21 out of 25 ) children in the steroid arm compared to 12% (3 out of 25) in non-steroid arm . The Z Score of Total Body Less Head was low in 15 of 19 children in the steroid arm compared to 1 of 21 children in the non steroid arm. The lowest TBLH Z Score was- 2.6 

Conclusions:

Linear growth retardation is a late marker of steroid toxicity. Pediatric BMD evaluation, when done in indicated cases, aids in early detection of bone changes. This could alert the clinician to adopt a steroid minimizing protocol where possible and address correctable factors such as Vit D insufficiency. The challenge of Pediatric BMD is the lack of reference data from the same population. The study suggests the  usefulness of  inculcating BMD DEXA as a supplementary tool to growth assessment by anthropometry to help minimise long term steroid toxicity on bone growth. The study is  limited by the small sample size and paucity of normative BMD data in paediatric population from India. However, BMD study can serve as an ancillary investigation to evaluate early bone changes in children on steroids

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.