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Inhaled corticosteroids and bone mineral density at school age: a follow-up study after early childhood wheezing
Virpi H Sidoroff1, Mari K Ylinen, Liisa M Kröger
1Department of Paediatrics, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Paediatrics, North-Karelia Central Hospital, Joensuu, Finland.
Insights
Inhaled corticosteroid (ICS) use in early childhood wheezing may be linked to lower bone mineral density (BMD) in school-aged children. Lower BMD was associated with longer duration and higher cumulative doses of ICS, suggesting careful dosing is important.
Area of Science:
- Pediatric Pulmonology
- Pediatric Endocrinology
- Bone Health Research
Background:
- Early childhood wheezing is common, and inhaled corticosteroids (ICS) are frequently prescribed.
- The long-term effects of ICS on bone mineral density (BMD) in children require further investigation.
- Understanding the relationship between ICS use and BMD is crucial for optimizing asthma management in pediatric populations.
Purpose of the Study:
- To evaluate the association between prior inhaled corticosteroid (ICS) use and bone mineral density (BMD) at school age.
- To assess BMD in a cohort of children previously hospitalized for wheezing in early childhood.
- To determine if cumulative ICS dose or duration of use correlates with BMD outcomes.
Main Methods:
- Prospective follow-up of 89 children hospitalized for wheezing before 24 months of age.
- BMD measurements (areal and volumetric) of the lumbar spine and femoral neck using DXA at a median age of 12.3 years.
- ICS exposure data collected via parental interviews and patient records, with cumulative doses and duration calculated.
Main Results:
- Regular ICS use for over 6 months before age 6 was linked to lower lumbar spine BMD.
- Higher cumulative ICS doses were associated with lower areal and volumetric BMD at the femoral neck.
- These associations remained significant after adjusting for age, sex, pubertal stage, height, weight, and systemic steroid use.
Conclusions:
- Childhood ICS use may be associated with reduced bone mineral density (BMD) in late school age.
- The findings underscore the importance of using the lowest effective ICS dose for maintaining asthma control.
- Further research may explore long-term skeletal implications of pediatric ICS therapy.
Objective:
The aim of the study was to evaluate the association between previous use of ICS and bone mineral density (BMD) at school age in a cohort followed after early childhood wheezing.
Methods:
As part of a prospective follow-up study after hospitalization for wheezing at <24 months of age, BMD was measured in 89 children at 12.3 (median) years of age. Data on ICS use were collected by interviewing the parents, and this was supplemented with data from patient records. Cumulative doses and the duration of ICS use were calculated. Areal BMD (BMDareal , g/cm(2) ) was measured by dual energy X-ray absorptiometry (DXA), and apparent volumetric BMD (aBMDvol , g/cm(3) ) was calculated, for the lumbar spine and femoral neck. Weight, height and pubertal stage were recorded.
Findings:
Age, sex, and pubertal stage were significantly associated with BMDareal and aBMDvol of the lumbar spine and BMDareal of the femoral neck. The regular use of ICS for >6 months at age <6 years was associated with a lower BMD of the lumbar spine. A lower BMDareal and aBMDvol of the femoral neck were associated with higher cumulative doses of ICS at age 0-12.3 (median) years. The results were robust to adjustment for age, sex, pubertal stage, height, weight, and use of systemic steroids.
Conclusion:
ICS use during childhood may be related to a decrease in BMD at late school age. It is important to use the lowest possible ICS dose that maintains adequate asthma control.
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