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J Bone Miner Res., 2009; 24(3):: 503-13, PMID: 19016583

Divergent Effects of Glucocorticoids on Cortical and Trabecular Compartment Bone Mineral Density in Childhood Nephrotic Syndrome

Jahr: 2009

Wetzsteon RJ, Shults J, Zemel BS, Gupta PU, Burnham JM, Herskovitz RM, Howard KM, Leonard MB


Abstract Glucocorticoid (GC) effects on skeletal development have not been established. The objective of this peripheral quantitative computed tomography (pQCT) study was to assess volumetric bone mineral density (vBMD) and cortical dimensions in childhood steroid-sensitive nephrotic syndrome (SSNS), a disorder with minimal independent deleterious skeletal effects. Tibia pQCT was used to assess trabecular and cortical vBMD, cortical dimensions and muscle area in 55 SSNS (age 5-19 yr) and over 650 control participants. Race-, sex-, and age- or tibia length-specific Z-scores were generated for pQCT outcomes. Bone biomarkers included bone-specific alkaline phosphatase and urinary deoxypyridinoline. SSNS participants had lower height Z-scores (p<0.0001) compared with controls. In SSNS, Z-scores for cortical area were greater [+0.37 (95% C.I. 0.09, 0.66); p=0.01], cortical vBMD were greater [+1.17 (0.89, 1.45); p<0.0001], and trabecular vBMD were lower [-0.60 (-0.89, -0.31); p<0.0001], compared with controls. Muscle area [+0.34 (0.08, 0.61); p=0.01] and fat area [+0.56 (0.27, 0.84); p<0.001] Z-scores were greater in SSNS, and adjustment for muscle area eliminated the greater cortical area in SSNS. Bone formation and resorption biomarkers were significantly and inversely associated with cortical vBMD in SSNS and controls, and were significantly lower in the 34 SSNS participants taking GC at the time of the study compared with controls. In conclusion, GCs in SSNS were associated with significantly greater cortical vBMD and cortical area, and lower trabecular vBMD, with evidence of low bone turnover. Lower bone biomarkers were associated with greater cortical vBMD. Studies are needed to determine the fracture implications of these varied effects.

GID: 1669; Letzte Änderung: 12.12.2008