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Corticosteroid use and bone mineral accretion in children with asthma: effect modification by vitamin D
Sze Man Tse1, H William Kelly, Augusto A Litonjua
1Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. reszt@channing.harvard.edu
Insights
Vitamin D insufficiency exacerbates corticosteroid-induced bone loss in boys with asthma. Low vitamin D levels in boys significantly increased the negative impact of oral corticosteroids on bone mineral accretion over time.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Bone Metabolism
Background:
- Corticosteroids negatively impact bone mineral accretion (BMA) in children.
- Vitamin D insufficiency is common in pediatric populations and linked to reduced bone mineral density (BMD).
Purpose of the Study:
- To investigate if vitamin D levels influence the adverse effects of corticosteroids on BMD in children with asthma.
Main Methods:
- Longitudinal study of 780 children (5-12 years) with mild-to-moderate asthma over 4.3 years.
- Assessed inhaled and oral corticosteroid (OCS) doses, baseline serum 25-hydroxyvitamin D3, and serial BMD via dual-energy x-ray absorptiometry.
- Calculated annual BMA rates.
Main Results:
- Baseline vitamin D levels significantly modified the OCS-BMA relationship in boys (P=.023).
- Vitamin D-insufficient boys showed decreased BMA with increased OCS use (P<.001).
- Vitamin D-insufficient boys on >2 OCS courses/year had double the BMA decrease compared to unexposed boys.
Conclusions:
- Vitamin D status is a critical factor in the bone health effects of OCSs in boys with asthma.
- Further research into vitamin D supplementation for children with poorly controlled asthma is warranted to support bone health.
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.
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