Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome

Phan, Véronique; Blydt-Hansen, Tom; Feber, Janusz; Alos, Nathalie; Arora, Sourabh; Atkinson, Stephanie; Bell, Lorraine; Clarson, Cheril; Couch, Robert; Cummings, Elizabeth A.; Filler, Guido; Grant, Ronald; Grimmer, Joanne; Hébert, Diane; Lentle, Brian C.; Ma, Jinhui; Matzinger, Mary Ann; Midgley, Julian; Pinsk, Maury; Rodd, Celia; Shenouda, Nazih; Stein, Robert; Stephure, David; Taback, Shayne; Williams, Kathryn; Rauch, Frank; Siminoski, Kerry; Ward, Leanne M.

doi:10.1007/s00198-013-2466-7

Cited by 52 publications

(48 citation statements)

References 39 publications

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“…At diagnosis, 8% of the children had anterior vertebral wedging (78) and normal BMD (16). Twelve months following the initiation of GC treatment, 6% of the patients developed incident VF, which mostly constituted mild vertebral deformities and were asymptomatic in nature (79). The lower prevalence of bone pathology in nephrotic syndrome compared to other GC-treated conditions suggests that cytokines may be the main cause of fractures in inflammatory conditions, as they activate osteoclasts through the RANKL-osteoprotegerin system.…”

Section: Chronic Inflammatory Conditions and Gc Therapymentioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Saraff

Högler

2015

European Journal of Endocrinology

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Osteoporosis in children can be primary or secondary due to chronic disease. Awareness among paediatricians is vital to identify patients at risk of developing osteoporosis. Previous fractures and backaches are clinical predictors, and low cortical thickness and low bone density are radiological predictors of fractures. Osteogenesis Imperfecta (OI) is a rare disease and should be managed in tertiary paediatric units with the necessary multidisciplinary expertise. Modern OI management focuses on functional outcomes rather than just improving bone mineral density. While therapy for OI has improved tremendously over the last few decades, this chronic genetic condition has some unpreventable, poorly treatable and disabling complications. In children at risk of secondary osteoporosis, a high degree of suspicion needs to be exercised. In affected children, further weakening of bone should be avoided by minimising exposure to osteotoxic medication and optimising nutrition including calcium and vitamin D. Early intervention is paramount. However, it is important to identify patient groups in whom spontaneous vertebral reshaping and resolution of symptoms occur to avoid unnecessary treatment. Bisphosphonate therapy remains the pharmacological treatment of choice in both primary and secondary osteoporosis in children, despite limited evidence for its use in the latter. The duration and intensity of treatment remain a concern for longterm safety. Various new potent antiresorptive agents are being studied, but more urgently required are studies using anabolic medications that stimulate bone formation. More research is required to bridge the gaps in the evidence for management of paediatric osteoporosis.

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Section: Chronic Inflammatory Conditions and Gc Therapymentioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Saraff

Högler

2015

European Journal of Endocrinology

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“…On the other hand, they cause bone fragility, and in some cases, fracture (3). The GCs directly inhibits the osteoblastic function by affecting GC receptors on the cells (4) and decreases the lifespan of osteoblasts by apoptosis (5).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Glucocorticoids on Bone Strength in Children with Renal Diseases

et al. 2016

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Background: We evaluated the effect of glucocorticoids (GCs) on bone strength via bone mineral density (BMD) scores and serum alkaline phosphatase (S-ALP) levels in children with idiopathic steroid-sensitive nephrotic syndrome (ISSNS) or IgA nephropathy (IgAN). Methods: Sixteen children with ISSNS and 13 with IgAN were eligible for this study. The BMD and S-ALP levels were measured before the initiation of steroid treatment (STx), one month after initiation of STx and one month after terminating STx (Phases 0, 1 and 2). For IgAN, scores and levels were measured before the initiation of STx (Phase 0) and 1, 3, 6, and 12 months after the initiation of STx (Phases 1, 2, 3, and 4). Results: In ISSNS, the BMD and S-ALP levels were significantly lower in Phase 1 than in Phase 0; however, scores and levels returned to baseline in Phase 2. In IgAN, BMD was significantly lower in Phase 2 than in Phase 0 while S-ALP levels were significantly lower in Phases 1, 2, and 3 compared to Phase 0. No significant difference was observed between Phase 0 and Phase 4. Conclusions: In ISSNS, bone strength recovered one month after terminating STx. In IgAN, bone strength recovered 10 months after tapering of STx.

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“…By history, two of them were on irregular dose of calcium only without vitamin D and one did not receive any calcium or vitamin D supplement treatment. This was found when Phan et al (2014) (20) studied 54 children followed to 12 months after steroid initiation. Three of 54 children with radiographs had incident vertebral fracture at 1 year.…”

Section: Moon Et Al (2014)mentioning

confidence: 87%

Osteocalcin Level in Children with Steroid Dependent/Frequently Relapsing and Steroid Resistant Nephrotic Syndrome

et al. 2017

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Background: Children with nephrotic syndrome (NS) may be at risk for metabolic bone disease because of biochemical derangement caused by renal disease as well as steroid therapy. Osteocalcin (OC) functions as an inhibitor of bone mineralization. We aimed to evaluate linear growth and bone turnover markers (including serum osteocalcin) in children with steroid-dependant/frequentlyrelapsing and steroid resistant NS in comparison to a matched control group.

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Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome

Abstract: Introduction-Vertebral fracture (VF) incidence following glucocorticoid (GC) initiation has not been previously reported in pediatric nephrotic syndrome.

Cited by 52 publications

References 39 publications

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

The Effects of Glucocorticoids on Bone Strength in Children with Renal Diseases

Osteocalcin Level in Children with Steroid Dependent/Frequently Relapsing and Steroid Resistant Nephrotic Syndrome

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