Effect of Steroid Therapy on Bone Mineral Density in Children with Minimal Change Nephrotic Syndrome

Son, Byeong Hee; Chung, Woo Yeong; Kim, Chul Ho

Abstract

PURPOSE
Osteoporosis and growth failure have been known one of the serious side effects of corticosteroid therapy especially in children. This study was designed to evaluate the effect of long-term administration of steroids on bone mineral density(BMD) in children with nephrotic syndrome and its relationship to cumulative steroid dose, the duration of therapy and sex. Meathods : The BMD of the spine and arm were measured by dual energy x-ray absorptiometry in 24 children with biopsy-proven minimal change nephrotic syndrome who have been revealed steroid dependent and/or frequent relapse in its clinical course and in age- and sex-matched healthy controls. The mean duration of steroid therapy was 37+/-29.8 months and the mean cumulative steroid doses was 12.8+/-7.7g/m2.
RESULTS
1) The BMD at arm was 0.57+/-0.06g/cm2 in patient group and 0.59+/- 0.06g/cm2 in control group. The BMD at spine was 0.68+/-0.1g/cm2 in patient group and 0.76+/-0.1g/ cm2 in control group. Compared with control group significant decrease in BMD was detected in patient group at arm(p=0.011) and spine(p<0.01). The bone loss at spine and arm was -10.6+/-7.44% and -3.7+/-5.5%, respectively. The bone loss was more prominant at spine(p<0.01). 2) Bone loss at arm was significantly correlated to the total cumulative dose of steroid(Y=-0.0029-0.294X, r=-0.4148, p=0.0434), but was not correlated to the duration of steroid(Y=-2.15-0.04X, r=0.1396, p=0.4619). At spine, there were no significant correlation between bone loss and the cumulative steroid doses(Y=-8.47-0.178X, r=-0.19397, p=0.363) and the duration of steroid therapy (Y=-9.75-0.025X, r=0.09081, p=0.6332).
CONCLUSIONS
The long-term use of steroid can induce significant bone loss at the both site of arm and spine. To minimize the extent of corticosteroid-induced bone loss, BMD measurement using dual energy x-ray absorptiometry in children with nephrotic syndrome would be helpful.