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Bone metabolism in children with asthma treated with inhaled beclomethasone dipropionate
P König1, L Hillman, C Cervantes
1Department of Child Health, University of Missouri-Columbia School of Medicine, Columbia 65212.
Insights
Inhaled beclomethasone, a corticosteroid, does not negatively impact bone density or increase bone resorption in children with asthma. This study found no significant differences in bone metabolism markers between treated and control groups.
Area of Science:
- Pediatric Endocrinology
- Respiratory Medicine
- Bone Metabolism
Background:
- Inhaled corticosteroids (ICS) are widely used for pediatric asthma management.
- Previous research suggests potential effects of ICS on bone metabolism in adults.
- The impact of ICS on pediatric bone health requires further investigation.
Purpose of the Study:
- To evaluate the effects of inhaled beclomethasone on bone metabolism in children with asthma.
- To assess bone mineral density, content, and relevant biochemical markers.
- To compare outcomes in children treated with beclomethasone, asthma controls, and healthy children.
Main Methods:
- A study involving children aged 4-17 years treated with inhaled beclomethasone (300-800 mcg/day) for at least 6 months.
- Bone mineral density and content were measured using radiographic absorptiometry, single-photon absorptiometry, and dual-energy x-ray absorptiometry.
- Serum levels of calcium, bone turnover markers (alkaline phosphatase, osteocalcin, tartrate-resistant acid phosphatase), and vitamin D were analyzed.
Main Results:
- No significant differences in bone mineral density or content were observed between the beclomethasone group and control groups (asthma and healthy).
- Serum levels of calcium, magnesium, zinc, alkaline phosphatase, parathyroid hormone, and vitamin D metabolites showed no significant changes.
- Tartrate-resistant acid phosphatase activity, a marker of bone resorption, was lower in the beclomethasone group, but urine calcium excretion did not differ. Asthma itself was associated with lower osteocalcin levels.
Conclusions:
- Inhaled beclomethasone, at doses up to 800 mcg/day, does not appear to reduce bone mineralization or increase bone resorption in children.
- Asthma itself may influence bone formation markers, complicating the assessment of ICS effects on bone formation.
- The findings support the safety of inhaled beclomethasone regarding pediatric bone health.
Abstract:
Previous studies have shown that inhaled corticosteroids can affect bone metabolism in adults. A study to assess the effect of inhaled beclomethasone, 300 to 800 micrograms/day for at least 6 months (mean 25 months), was therefore undertaken in children. In part 1 of the study, 18 children with asthma, aged 4 to 17 years (mean 10.1 years), were compared with an age- and sex-matched group of children with asthma not treated with corticosteroids. In part 2, eight more pairs were compared. Comparisons were also made with 61 healthy children. Bone mineral density measured by radiographic absorptiometry, and bone mineral content measured by single-photon absorptiometry and by dual-energy x-ray absorptiometry, showed no significant differences. Serum levels of calcium, magnesium, zinc, total alkaline phosphatase, bone specific alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D also showed no differences. The activity of tartrate-resistant acid phosphatase, a marker of bone resorption, was significantly lower in the beclomethasone group than in both the asthma control and the normal control groups, but urine calcium excretion did not differ. Patients with asthma had lower serum osteocalcin and higher serum copper levels than control subjects without asthma, but treatment with beclomethasone did not affect these values. We conclude that inhaled beclomethasone (up to 800 micrograms/day) does not reduce bone mineralization or increase bone resorption. Effects on bone formation were difficult to assess because asthma per se caused a significant reduction in osteocalcin, a sensitive marker of bone formation.