EFFECT ON CORTICAL AND TRABECULAR BONE MASS OF DIFFERENT ANTIINFLAMMATORY TREATMENTS IN PREADOLESCENT CHILDREN WITH CHRONIC ASTHMA

Bone metabolism and density have been shown to be abnormal in adult as thmatic patients treated with inhaled corticosteroids. Because the lar gest increases in bone growth and mineral deposition occur during chil dhood and adolescence, we performed a cross-sectional evaluation of co rtical and trabecular bone mass by dual-photon absorptiometry at the p roximal one third of the radius (cortical bone) and by dual-energy X-r ay absorptiometry at the L2-L4 lumbar spine (trabecular bone) in 64 pr epubertal asthmatic children receiving beclomethasone dipropionate (BD P) or cromolyn sodium (CS). Dual-energy X-ray absorptiometry was perfo rmed by anteroposterior scan and also by lateral vertebral scan in ord er to exclude the posterior elements of the vertebrae, which are compo sed mainly of cortical bone and which are less sensitive to the negati ve effect of steroids. Furthermore, we calculated ''volumetric'' bone density, dividing lateral mineral content by the vertebral volume. Bon e mineral areal density and volume bone density did not differ in chil dren receiving BDP for 6.7 +/- 1.3 mo at a mean dose of 319.3 +/- 130 mu g/d compared with those in children treated with CS. Furthermore, a nteroposterior bone density in our study population was in agreement w ith published normative data and with that of normal age-related healt hy nonasthmatic children living in the same area and with the same die tary intake of calcium. No normal values are available for lateral and calculated-volume bone density. In conclusion, treatment with BDP doe s not appear to have an adverse effect on bone mass in prepubertal chi ldren with mild moderate asthma. Longitudinal studies should be perfor med in order to evaluate the effect of early introduction of inhaled c orticosteroids in children with mild asthma.