Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/cep.2021.00045    [Accepted]
Published online November 18, 2021.
Effect of 2–6 weeks of systemic steroids on bone mineral density in children
Athira Kunyil1  , Somdipa Pal1  , Namrita Sachdev2  , Tribhuvan Pal Yadav1 
1Departments of Pediatrics Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
2Departments of Radiodiagnosis Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Correspondence: 
Tribhuvan Pal Yadav, Email: tribhuvanpal@gmail.com
Received: 15 January 2021   • Revised: 28 September 2021   • Accepted: 1 October 2021
Abstract
Background
The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown.
Purpose
To determine the effect of the use of systemic steroids for 2–6 weeks on BMD and BMC in pediatric patients.
Methods
Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2–6 weeks and 25 age- and sex-matched controls were enrolled. BMC, BMD, and Z scores of the whole body (WB), lumbar spine (LS), non-dominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy X-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student’s t-test and the chi-square test or Fisher’s exact test, respectively. Pairwise comparisons employed Bonferroni correction.
Results
Statistically significant decreases in BMC, BMD, and all Z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose.
Conclusion
The use of systemic steroids for 2–6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.
Key Words: Systemic steroids, Bone Mineral Density , Bone mineral content , Z score


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