Document Detail


Glucocorticoid effects on changes in bone mineral density and cortical structure in childhood nephrotic syndrome.
MedLine Citation:
PMID:  23044926     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The impact of glucocorticoids (GC) on skeletal development has not been established. The objective of this study was to examine changes in volumetric bone mineral density (vBMD) and cortical structure over 1 year in childhood nephrotic syndrome (NS) and to identify associations with concurrent GC exposure and growth. Fifty-six NS participants, aged 5 to 21 years, were enrolled a median of 4.3 (0.5 to 8.1) years after diagnosis. Tibia peripheral quantitative computed tomography (pQCT) scans were obtained at enrollment and 6 and 12 months later. Sex, race, and age-specific Z-scores were generated for trabecular vBMD (TrabBMD-Z), cortical vBMD (CortBMD-Z), and cortical area (CortArea-Z) based on >650 reference participants. CortArea-Z was further adjusted for tibia length-for-age Z-score. Quasi-least squares regression was used to identify determinants of changes in pQCT Z-scores. At enrollment, mean TrabBMD-Z (-0.54 ± 1.32) was significantly lower (p = 0.0001) and CortBMD-Z (0.73 ± 1.16, p < 0.0001) and CortArea-Z (0.27 ± 0.91, p = 0.03) significantly greater in NS versus reference participants, as previously described. Forty-eight (86%) participants were treated with GC over the study interval (median dose 0.29 mg/kg/day). On average, TrabBMD-Z and CortBMD-Z did not change significantly over the study interval; however, CortArea-Z decreased (p = 0.003). Greater GC dose (p < 0.001), lesser increases in tibia length (p < 0.001), and lesser increases in CortArea-Z (p = 0.003) were independently associated with greater increases in CortBMD-Z. Greater increases in tibia length were associated with greater declines in CortArea-Z (p < 0.01); this association was absent in reference participants (interaction p < 0.02). In conclusion, GC therapy was associated with increases in CortBMD-Z, potentially related to suppressed bone formation and greater secondary mineralization. Conversely, greater growth and expansion of CortArea-Z (ie, new bone formation) were associated with declines in CortBMD-Z. Greater linear growth was associated with impaired expansion of cortical area in NS. Studies are needed to determine the fracture implications of these findings.
Authors:
Anne Tsampalieros; Pooja Gupta; Michelle R Denburg; Justine Shults; Babette S Zemel; Sogol Mostoufi-Moab; Rachel J Wetzsteon; Rita M Herskovitz; Krista M Whitehead; Mary B Leonard
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research     Volume:  28     ISSN:  1523-4681     ISO Abbreviation:  J. Bone Miner. Res.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-18     Completed Date:  2013-08-29     Revised Date:  2014-06-12    
Medline Journal Info:
Nlm Unique ID:  8610640     Medline TA:  J Bone Miner Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  480-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Bone and Mineral Research.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Bone Density*
Child
Child, Preschool
Female
Glucocorticoids / therapeutic use*
Humans
Male
Nephrotic Syndrome / drug therapy*,  physiopathology
Tomography, X-Ray Computed
Grant Support
ID/Acronym/Agency:
K23 DK093556/DK/NIDDK NIH HHS; K24 DK076808/DK/NIDDK NIH HHS; K24-DK07680/DK/NIDDK NIH HHS; R01 DK060030/DK/NIDDK NIH HHS; R01-DK060030/DK/NIDDK NIH HHS; UL1-RR-024134/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Glucocorticoids
Comments/Corrections

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