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[Long-term steroid therapy in children: is adjunct therapy relevant in nephrotic syndrome?]

J Bacchetta1, J Harambat, P Cochat

  • 1Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, université de Lyon, 69677 Bron, France.

Archives De Pediatrie : Organe Officiel De La Societe Francaise De Pediatrie
|October 28, 2008
PubMed

Insights

Glucocorticoids harm bone development in children. Routine vitamin D and calcium, alongside lifestyle changes, may help prevent bone disease in children undergoing long-term steroid treatment.

Area of Science:

  • Pediatric Endocrinology
  • Bone Metabolism
  • Pharmacology

Background:

  • Glucocorticoids negatively impact bone formation by inhibiting osteoblasts.
  • Long-term corticosteroid use in children can cause delayed bone maturation, hypogonadism, and reduced Insulin-like Growth Factor 1 (IGF1).

Purpose of the Study:

  • To systematically review interventions for preventing bone disease in children receiving long-term steroid therapy.

Main Methods:

  • A systematic review of 12 clinical trials was conducted.
  • Interventions included calcium, vitamin D, growth hormone, calcitonin, and bisphosphonates.
  • Limited number of randomized controlled trials (n=7) precluded meta-analysis.

Main Results:

  • Calcium and vitamin D supplementation showed potential benefits for bone health in children with nephrotic syndrome on long-term steroids.
  • Few high-quality randomized controlled trials were identified.

Conclusions:

  • Routine vitamin D supplementation is recommended for children on long-term steroid therapy.
  • Steroid-sparing protocols and comprehensive bone protection strategies (calcium, sun exposure, physical activity) are advised.

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