Inhaled corticosteroids may have a beneficial effect on bone metabolism in newly diagnosed asthmatic children.
BACKGROUND
The adverse effect of inhaled corticosteroids (ICS) treatment on bone metabolism in children with asthma is still controversial, and a possible beneficial effect of vitamin D added to ICS on bone turnover is uncertain.


OBJECTIVE
We conducted a randomized, double-blind, parallel-group, 6-month trial to assess the effects of a medium and high dose of ICS and a high-dose ICS with vitamin D on bone metabolism in children with newly diagnosed atopic asthma.


METHODS
96 children were equally randomized to 4 groups receiving the following doses of inhaled budesonide [μg/day]: 400 (ICS 400 group), 800 (ICS 800 group), 800 with oral vitamin D (ICS 800 with vit D group), and montelukast as a control (control group). Markers of bone production (osteocalcin, alkaline phosphatase) and bone degradation (amino-terminal cross-linked telopeptide of type I collagen--NTx, carboxy-terminal telopeptides of type I collage), and also concentration of 25-hydroxycholecalciferol (25OH D) and calcium-phosphorus balance (calcium, phosphorus, parathormon-PTH) in serum and/or urine were assessed twice: before and after 6 months of treatment.


RESULTS
We obtained a significant decrease in phosphorus and PTH serum levels in ICS 400 and ICS 800 with vit D groups compared to control group, and a significant decrease of NTx urine level in ICS 800 with vit D group.


CONCLUSIONS
Medium doses of inhaled corticosteroids exert an advantageous effect on bone metabolism in newly diagnosed asthmatic children. Vitamin D together with a high dose of inhaled corticosteroids has a beneficial effect on both calcium-phosphorus balance and collagen turnover.
Department of Pediatrics and Allergy, Medical University of Lodz, N Copernicus Hospital, 62 Pabianicka Street, 93-513 Lodz, Poland. alergol@kopernik.lodz.pl
Iwona
I
Stelmach
Malgorzata
M
Olszowiec-Chlebna
Joanna
J
Jerzynska
Tomasz
T
Grzelewski
Włodzimierz
W
Stelmach
Pawel
P
Majak
D000085:Acetates / Q000627:therapeutic use; D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy* / Q000378:metabolism; D001842:Bone and Bones / Q000378:metabolism*; D019819:Budesonide / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010758:Phosphorus / Q000097:blood; D011804:Quinolines / Q000627:therapeutic use; D013440:Sulfides
D000085:Acetates; D003521:Cyclopropanes; D005938:Glucocorticoids; D010281:Parathyroid Hormone; D011804:Quinolines; D013440:Sulfides; D010758:Phosphorus; D019819:Budesonide; C093875:montelukast