title: Prevention of steroid-induced low bone mineral density in children with renal diseases: a systematic review.
abstract: BACKGROUND
  Children with renal diseases who are treated with glucocorticoids are at increased risk of developing osteoporosis and fractures. However, there is no common strategy for prevention of corticosteroid-induced osteoporosis. The present systematic review was performed to determine whether prevention of bone loss by calcium (Ca), vitamin D (vit D) and/or bisphosphonates is justified, safe and efficacious in children treated with steroids for various renal diseases.
  
  
  METHODS
  
  
  
  METHODS
  Medline, Embase, Central were searched from 1961 up to 2012. Randomized controlled trials (RCTs) and observational studies concerning children ≤18 years with renal diseases requiring steroids were included.
  
  
  RESULTS
  The search strategy retrieved 2482 studies. Four RCTs including 166 patients and one observational study including 100 children met our eligibility criteria. One RCT and the observational study concerned treatment with Ca/vit D, one RCT with bisphosphonates and two RCTs with a combination of both therapies. All described a significant improvement in bone mineral density (BMD) in the treatment group compared with the control group.
  
  
  CONCLUSIONS
  Ca combined with vit D is recommended to prevent bone disease in children with renal diseases treated with steroids. Because of side effects, bisphosphonates should be reserved for the treatment of severe osteoporosis when Ca and/or vit D supplementation has failed.
authors: Department of Pediatric Nephrology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
authors: Mariken P
authors: MP
authors: Gruppen
authors: Jean-Claude
authors: JC
authors: Davin
authors: Michiel J
authors: MJ
authors: Oosterveld
authors: Michiel F
authors: MF
authors: Schreuder
authors: Eiske M
authors: EM
authors: Dorresteijn
authors: Sharon P
authors: SP
authors: Kramer
authors: Antonia H
authors: AH
authors: Bouts
mesh_terms: D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001847:Bone Diseases / Q000209:etiology / Q000517:prevention & control*; D002136:Calcium, Dietary / Q000008:administration & dosage; D019587:Dietary Supplements; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D013256:Steroids / Q000009:adverse effects*; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D013256:Steroids; D014807:Vitamin D
keywords: bisphosphonates; calcium/vitamin D; osteoporosis; renal diseases; steroids