Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a...

Area of Science:

• Pediatric Endocrinology
• Bone Metabolism
• Nephrology

Background:

• Glucocorticoids are essential for treating childhood nephrotic syndrome but can cause adverse skeletal effects.
• Current guidelines lack robust strategies for preventing glucocorticoid-induced bone loss in pediatric patients.
• High-dose, short-term glucocorticoid therapy necessitates evaluating bone health protective measures.

Purpose of the Study:

• To assess the efficacy of prophylactic calcium and vitamin D in preserving bone health.
• To evaluate the impact on bone mineral content (BMC) and bone mineral density (BMD) in children with new-onset nephrotic syndrome (NS).
• To investigate the role of these supplements during short-term, high-dose glucocorticoid treatment.

Main Methods:

• A prospective, randomized, controlled, single-blind study involved 41 steroid-naïve, pre-pubertal children with NS.
• Participants received 12 weeks of high-dose prednisolone therapy.
• The intervention group (IG) received daily vitamin D (1,000 IU) and elemental calcium (500 mg), while the control group (CG) did not.

Main Results:

• The intervention group demonstrated an 11.2% increase in lumbar spine bone mineral content (BMC), contrasting with an 8.9% decrease in the control group (p < 0.0001).
• A net intervention-attributable difference of 20.1% in BMC was observed.
• While both groups showed an increase in bone mineral density (BMD), the difference between groups was not statistically significant (p = 0.27).

Conclusions:

• Short-term, high-dose glucocorticoid therapy significantly reduces lumbar spine BMC in children with NS.
• Co-administration of vitamin D and calcium effectively prevents this glucocorticoid-induced bone loss.
• The supplementation strategy not only preserves but also enhances lumbar spine BMC in this pediatric population.