title: A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children.
abstract: OBJECTIVE
  To summarize the published effects of systemic glucocorticoid therapy on bone mineral density (BMD) and fractures in children.
  
  
  METHODS
  We performed a systematic review and meta-analysis of existing literature, using Medline, CINAHL, and Cochrane databases to identify studies of BMD or fractures in children ≤18 years taking systemic glucocorticoid therapy. We excluded studies of inhaled glucocorticoids, chemotherapy, and organ transplantation. Two authors reviewed abstracts for inclusion, read full-text articles to extract data, and rated each study using the Downs-Black scale.
  
  
  RESULTS
  A total of 16 studies met eligibility criteria, including 10 BMD (287 children) and six fracture (37,819 children) studies. Spine BMD was significantly lower (-0.18; 95% CI = -0.25; -0.10 g/cm(2)) in children taking glucocorticoid therapy, compared to age- and gender-matched healthy controls. Spine BMD was also lower (-0.14; 95% CI = -0.27; 0.00 g/cm(2)) in children taking glucocorticoids, compared to children with the same disease not taking glucocorticoids. Incident clinical fracture rates varied from 2% to 33%. Morphometric vertebral fracture incidence ranged from 6% to 10%, and prevalence was 29-45%.
  
  
  CONCLUSIONS
  Published data suggest that children treated with glucocorticoid therapy have lower spine BMD compared to healthy children. Whether children receiving glucocorticoid therapy have lower spine BMD compared to children with milder disease not requiring such therapy is not certain. Clinical and morphometric vertebral fractures are common, although only one study assessed fracture rates in healthy controls. Additional well-designed, prospective studies are needed to evaluate the skeletal effects of glucocorticoid therapy in children.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: keh@medicine.wisc.edu.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hansen
authors.affiliation: Department of Dermatology, Kaiser Permanente, La Mesa, CA.
authors.forename: Brian
authors.initials: B
authors.lastname: Kleker
authors.affiliation: Department of Medicine, Division of Infectious Disease, William S Middleton Veterans Hospital, Madison, WI; Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
mesh_terms: D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D005938:Glucocorticoids / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010024:Osteoporosis / Q000139:chemically induced*; D012216:Rheumatic Diseases / Q000188:drug therapy
chemical_list: D005938:Glucocorticoids
keywords: Bone mineral density; Children; Fracture; Glucocorticoid therapy; Meta-analysis; Systematic review