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Published on: January 29, 2018
Treatment of glucocorticoid-induced low bone mineral density in children: a systematic review
Arundathi Jayasena1, Navoda Atapattu, Sarath Lekamwasam
1Paediatric Endocrinology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka.
Insights
Glucocorticoid (GC) therapy can cause bone loss in children. Bisphosphonates, vitamin D derivatives with calcium, and vitamin K2 show promise in preventing or treating this bone loss.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Bone Metabolism
Background:
- Glucocorticoid (GC) therapy is essential for managing various pediatric conditions.
- Long-term GC use is associated with significant bone loss and reduced bone mineral density (BMD) in children.
- Effective management strategies are needed to mitigate GC-induced bone complications.
Purpose of the Study:
- To systematically review and critically evaluate treatment options for managing bone loss in children using glucocorticoids.
- To assess the efficacy of different therapeutic interventions in preserving bone health during long-term GC therapy.
Main Methods:
- A systematic literature search was conducted across major databases including PubMed, Cochrane, ClinicalTrials.gov, and Ovid up to March 1, 2013.
- Seven clinical trials were selected based on predefined inclusion and exclusion criteria after reviewing 34 eligible retrievals.
- Studies focused on bisphosphonates, vitamin D derivatives (alfacalcidol, calcitriol), vitamin K2 (menatetrenone), and calcium supplementation.
Main Results:
- Bisphosphonates (alendronate, pamidronate) demonstrated efficacy in improving BMD or preventing bone loss in children on GC therapy.
- Vitamin K2 (menatetrenone) combined with alfacalcidol preserved BMD in children receiving long-term GCs.
- Calcium and alfacalcidol, or calcitriol with calcium, also showed benefits in preventing or retarding GC-induced bone loss.
Conclusions:
- Vitamin D derivatives (calcitriol, alfacalcidol) combined with adequate calcium are suitable for simultaneous initiation with long-term GC therapy in children.
- For children already on GCs or experiencing bone loss, oral pamidronate or alendronate are viable treatment options based on availability.
Aims:
The aim of this systematic review was to evaluate, critically, the treatment options used in the management of bone loss associated with glucocorticoid (GC) use among children.
Methods:
We performed a systematic search using PubMed, Cochrane clinical trial registry, Clinicaltiral.gov and Ovid databases (1 March, 2013). The search resulted in 34 eligible retrievals. Of them, seven clinical trials that fulfilled the inclusion and exclusion criteria were selected by two authors.
Results:
Four studies have compared the effectiveness of bisphosphonates in the treatment of GC-induced low bone mineral density (BMD) in children. Remaining studies were on menatretenone + alfacacidol versus alfacalcidol alone, calcium + vitamin D versus placebo and alfacalcidol versus menatetrenone. In the four studies, bisphosphonates have shown the ability either to improve BMD or prevent bone loss associated with GC use in children. However, alendronate either in oral or intravenous routes and oral pamidronate were the only bisphosphnates that have been studied in children. Vitamin K2 (menatetrenone) combined with alfacalcidol has also preserved BMD in children on long-term GC therapy. Calcium combined with alfacalcidol has also prevented bone loss, greater than menatetrenone. Calcitriol together with Calcium in conventional doses has retarded bone loss, although the combination could not completely prevent the process.
Conclusions:
Vitamin D derivatives such as calcitriol or alfacalcidol together with adequate calcium can be considered suitable treatment options to be started simultaneously when long-term GC therapy is needed in children. For children who have been on GCs or have already lost BMD, either oral pamidronate or alendronate in oral/intravenous routes can be considered based on the availability.
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