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A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children

Karen E Hansen1, Brian Kleker2, Nasia Safdar3

  • 1Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Seminars in Arthritis and Rheumatism
|April 1, 2014
PubMed

Insights

Systemic glucocorticoid therapy in children is linked to lower spine bone mineral density (BMD) and increased fracture risk. Further research is needed to fully understand these skeletal effects.

Area of Science:

  • Pediatric Endocrinology
  • Bone Metabolism
  • Pharmacology

Background:

  • Systemic glucocorticoid therapy is widely used in pediatric medicine.
  • Concerns exist regarding its potential adverse effects on bone health in children.
  • Understanding these effects is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To systematically review and synthesize the published evidence on the impact of systemic glucocorticoid therapy on bone mineral density (BMD) and fracture incidence in children.
  • To quantify the association between glucocorticoid use and skeletal outcomes in pediatric populations.

Main Methods:

  • A systematic review and meta-analysis of studies identified through Medline, CINAHL, and Cochrane databases.
  • Inclusion criteria focused on children (≤18 years) receiving systemic glucocorticoids, excluding inhaled steroids, chemotherapy, and organ transplant recipients.
  • Study quality was assessed using the Downs-Black scale.

Main Results:

  • Ten studies on BMD and six on fractures met eligibility criteria, involving 287 and 37,819 children, respectively.
  • Children on glucocorticoid therapy exhibited significantly lower spine BMD compared to healthy controls (-0.18 g/cm²).
  • Fracture incidence varied, with morphometric vertebral fractures showing a 6-10% incidence and 29-45% prevalence.

Conclusions:

  • Children treated with systemic glucocorticoids demonstrate reduced spine BMD compared to healthy peers.
  • The comparative effect on BMD versus children with similar conditions not requiring glucocorticoids remains uncertain.
  • Further high-quality prospective studies are essential to elucidate the full spectrum of skeletal effects in pediatric glucocorticoid users.
Abstract

Keywords:
Bone mineral densityChildrenFractureGlucocorticoid therapyMeta-analysisSystematic review

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