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Previous Volume 351:868-875 August 26, 2004 Number 9 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Bachrach, L. K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Glucocorticoids suppress bone formation, impair growth, and induce obesity. We determined the effects of long-term treatment with glucocorticoids on bone mineral content in children with glucocorticoid-sensitive nephrotic syndrome, a disorder with minimal known independent effects on bone.

Methods We performed dual-energy x-ray absorptiometry of the whole body and spine in 60 children and adolescents with the nephrotic syndrome and 195 control subjects. We used linear regression analysis of log-transformed values to compare the bone mineral content in patients with that in controls.

Results Patients had received an average of 23,000 mg of glucocorticoids and were shorter (P=0.008) and had a greater body-mass index (P<0.001) than controls. The bone mineral content of the spine, adjusted for bone area, age, sex, degree of maturation (Tanner stage), and race, did not differ significantly between patients and controls (ratio, 0.99; 95 percent confidence interval, 0.96 to 1.02; P=0.51). After adjustment for the z score for body-mass index, the bone mineral content of the spine was significantly lower in patients than in controls (0.96; 95 percent confidence interval, 0.92 to 0.99; P=0.01). Whole-body bone mineral content, adjusted for height, age, sex, degree of maturation, and race, was significantly higher in patients than in controls (ratio, 1.11; 95 percent confidence interval, 1.05 to 1.18; P<0.001); however, the addition of the z score for body-mass index to the model eliminated the association with the nephrotic syndrome (ratio, 0.99; 95 percent confidence interval, 0.94 to 1.03; P=0.55).

Conclusions Intermittent treatment with high-dose glucocorticoids during growth does not appear to be associated with deficits in the bone mineral content of the spine or whole body relative to age, bone size, sex, and degree of maturation. Glucocorticoid-induced increases in body-mass index were associated with increased whole-body bone mineral content and maintenance of the bone mineral content of the spine.

Source Information

From the Department of Pediatrics, Children's Hospital of Philadelphia (M.B.L., B.S.Z., B.J.F., V.A.S.); and the Departments of Pediatrics (M.B.L., B.S.Z., B.J.F., V.A.S.), Medicine (H.I.F.), and Biostatistics and Epidemiology (M.B.L., H.I.F., J.S., B.J.F.), University of Pennsylvania School of Medicine — both in Philadelphia.

Address reprint requests to Dr. Leonard at the Department of Pediatrics, Children's Hospital of Philadelphia, CHOP N., Rm. 1564, Philadelphia, PA 19104, or at leonard{at}email.chop.edu.

Full Text of this Article

Related Letters:

Glucocorticoids and Bone Mineral Content in the Childhood Nephrotic Syndrome
Gulati S., Gulati K., Sugiyama T., Tanaka H., Taguchi T., Cooper M. S., Stewart P. M., Leonard M. B., Zemel B. S., Stallings V. A.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:2655-2657, Dec 16, 2004. Correspondence

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