title: Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation.
abstract: OBJECTIVE
  The aim of the study was to examine the association of corticosteroid exposure and other skeletal risk factors with bone mineral density (BMD) and fractures following pediatric liver transplantation (LT) at a large single center.
  
  
  METHODS
  Lumbar spine BMD, measured using dual-energy x-ray absorptiometry (DXA), was corrected for bone age in 52 ambulatory children ages 4 to 18 years, at least 1 year post-LT. Potential risk factors for skeletal health such as corticosteroid exposure, dietary and lifestyle factors, and growth and fracture occurrence, were related to BMD using univariate and multivariate regression analyses.
  
  
  RESULTS
  The prevalence of low BMD (z score <-2) and post-LT fractures was 3 of 52 (5.8%) and 11 of 52 (21%), respectively. Univariate analysis revealed age >10 years at LT and body mass index (BMI) < 85th percentile at time of DXA were significantly associated with BMD (both P = 0.02). BMD did not correlate with corticosteroid dosage in the first year post-LT, the year before DXA or cumulative lifetime exposure. A cholestatic primary LT indication, acute rejection episodes, and fractures post-LT were not associated with BMD. Extracurricular physical activity, vitamin D, and calcium intake were not associated with BMD or fractures. Multivariate linear regression revealed increased time post-LT (P = 0.04) and higher BMI z score at time of DXA (P = 0.02) as the strongest independent variables associated with greater BMD.
  
  
  CONCLUSIONS
  Neither corticosteroid exposure nor a cholestatic primary indication for LT influenced BMD, which was largely normal in this ambulatory group. Children and adolescents undergoing LT after the age of 10 years and those with low BMI post-LT may be at greatest risk of poor skeletal health later in life, and thus a potential target patient population to benefit from preventive interventions.
authors.affiliation: SickKids Transplant Centre, the Hospital for Sick Children, University of Toronto, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Nightingale
authors.forename: Fiona D
authors.initials: FD
authors.lastname: McEwan-Jackson
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
authors.forename: Colin
authors.initials: C
authors.lastname: Macarthur
authors.forename: Amina Z
authors.initials: AZ
authors.lastname: Khambalia
authors.forename: Lisha
authors.initials: L
authors.lastname: Lo
authors.forename: Annie
authors.initials: A
authors.lastname: Fecteau
authors.forename: Vicky L
authors.initials: VL
authors.lastname: Ng
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D015992:Body Mass Index; D018488:Bone Demineralization, Pathologic / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D015519:Bone Density; D002136:Calcium, Dietary / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D050723:Fractures, Bone / Q000473:pathology; D006801:Humans; D007223:Infant; D008019:Life Style; D016014:Linear Models; D016031:Liver Transplantation; D008159:Lumbar Vertebrae / Q000378:metabolism; D008297:Male; D015999:Multivariate Analysis; D011184:Postoperative Period; D015995:Prevalence; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D002136:Calcium, Dietary; D014807:Vitamin D