BACKGROUND: The adverse effects of corticosteroids on bone mineral accretion (BMA) have been well documented. Vitamin D insufficiency, a prevalent condition in the pediatric population, has also been associated with decreased bone mineral density (BMD). OBJECTIVE: We sought to determine whether children with asthma who have lower vitamin D levels are more susceptible to the negative effects of corticosteroids on BMD over time. METHODS:Children aged 5 to 12 years with mild-to-moderate asthma who participated in the Childhood Asthma Management Program were followed for a mean of 4.3 years. Total doses of inhaled corticosteroids and oral corticosteroids (OCSs) were recorded, serum 25-hydroxyvitamin D3 levels were measured at the beginning of the trial, and serial dual-energy x-ray absorptiometry scans of the lumbar spine were performed. Annual BMA rates were defined as follows: [(BMD at 4 years' follow-up - BMD at baseline)/4 years]. RESULTS:BMA was calculated for 780 subjects. In boys baseline vitamin D levels significantly modified the relationship between OCSs and BMA (vitamin D × OCS interaction, P= .023). Stratification by vitamin D levels showed a decrease in BMA with increased use of OCSs in vitamin D-insufficient boys only (P< .001). Compared with vitamin D-sufficient boys, vitamin D-insufficient boys exposed to more than 2 courses of OCSs per year had twice the decrease in BMA rate (relative to boys who were OCS unexposed). CONCLUSIONS:Vitamin D levels significantly modified the effect of OCSs on BMA in boys. Further research is needed to examine whether vitamin D supplementation in children with poorly controlled asthma might confer benefits to bone health.
RCT Entities:
BACKGROUND: The adverse effects of corticosteroids on bone mineral accretion (BMA) have been well documented. Vitamin Dinsufficiency, a prevalent condition in the pediatric population, has also been associated with decreased bone mineral density (BMD). OBJECTIVE: We sought to determine whether children with asthma who have lower vitamin D levels are more susceptible to the negative effects of corticosteroids on BMD over time. METHODS:Children aged 5 to 12 years with mild-to-moderate asthma who participated in the Childhood Asthma Management Program were followed for a mean of 4.3 years. Total doses of inhaled corticosteroids and oral corticosteroids (OCSs) were recorded, serum 25-hydroxyvitamin D3 levels were measured at the beginning of the trial, and serial dual-energy x-ray absorptiometry scans of the lumbar spine were performed. Annual BMA rates were defined as follows: [(BMD at 4 years' follow-up - BMD at baseline)/4 years]. RESULTS:BMA was calculated for 780 subjects. In boys baseline vitamin D levels significantly modified the relationship between OCSs and BMA (vitamin D × OCS interaction, P= .023). Stratification by vitamin D levels showed a decrease in BMA with increased use of OCSs in vitamin D-insufficient boys only (P< .001). Compared with vitamin D-sufficient boys, vitamin D-insufficient boys exposed to more than 2 courses of OCSs per year had twice the decrease in BMA rate (relative to boys who were OCS unexposed). CONCLUSIONS:Vitamin D levels significantly modified the effect of OCSs on BMA in boys. Further research is needed to examine whether vitamin D supplementation in children with poorly controlled asthma might confer benefits to bone health.
Authors: Yu Z Bagger; László B Tankó; Peter Alexandersen; Henrik B Hansen; Gerong Qin; Claus Christiansen Journal: Osteoporos Int Date: 2005-10-28 Impact factor: 4.507
Authors: I M van der Sluis; M A J de Ridder; A M Boot; E P Krenning; S M P F de Muinck Keizer-Schrama Journal: Arch Dis Child Date: 2002-10 Impact factor: 3.791
Authors: H K Genant; S Grampp; C C Glüer; K G Faulkner; M Jergas; K Engelke; S Hagiwara; C Van Kuijk Journal: J Bone Miner Res Date: 1994-10 Impact factor: 6.741
Authors: H-W Park; S Tse; W Yang; H W Kelly; S C Kaste; C-H Pui; M V Relling; K G Tantisira Journal: Pharmacogenomics J Date: 2016-02-09 Impact factor: 3.550
Authors: Gherardo Mazziotti; Anna Maria Formenti; Robert A Adler; John P Bilezikian; Ashley Grossman; Emilia Sbardella; Salvatore Minisola; Andrea Giustina Journal: Endocrine Date: 2016-10-20 Impact factor: 3.633
Authors: Piotr Dobrowolski; Ewa Tomaszewska; Siemowit Muszyński; Tomasz Blicharski; Stefan G Pierzynowski Journal: Exp Biol Med (Maywood) Date: 2017-01-01