Treatment of glucocorticoid-induced low bone mineral density in children: a systematic review.
OBJECTIVE
The aim of this systematic review was to evaluate, critically, the treatment options used in the management of bone loss associated with glucocorticoid (GC) use among children.


METHODS
We performed a systematic search using PubMed, Cochrane clinical trial registry, Clinicaltiral.gov and Ovid databases (1 March, 2013). The search resulted in 34 eligible retrievals. Of them, seven clinical trials that fulfilled the inclusion and exclusion criteria were selected by two authors.


RESULTS
Four studies have compared the effectiveness of bisphosphonates in the treatment of GC-induced low bone mineral density (BMD) in children. Remaining studies were on menatretenone + alfacacidol versus alfacalcidol alone, calcium + vitamin D versus placebo and alfacalcidol versus menatetrenone. In the four studies, bisphosphonates have shown the ability either to improve BMD or prevent bone loss associated with GC use in children. However, alendronate either in oral or intravenous routes and oral pamidronate were the only bisphosphnates that have been studied in children. Vitamin K2 (menatetrenone) combined with alfacalcidol has also preserved BMD in children on long-term GC therapy. Calcium combined with alfacalcidol has also prevented bone loss, greater than menatetrenone. Calcitriol together with Calcium in conventional doses has retarded bone loss, although the combination could not completely prevent the process.


CONCLUSIONS
Vitamin D derivatives such as calcitriol or alfacalcidol together with adequate calcium can be considered suitable treatment options to be started simultaneously when long-term GC therapy is needed in children. For children who have been on GCs or have already lost BMD, either oral pamidronate or alendronate in oral/intravenous routes can be considered based on the availability.
Paediatric Endocrinology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka.
Arundathi
A
Jayasena
Navoda
N
Atapattu
Sarath
S
Lekamwasam
D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002118:Calcium / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D019587:Dietary Supplements; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D014807:Vitamin D; D002118:Calcium
bone mineral density; children; glucocorticiods