BONE-MINERAL DENSITY AND BONE METABOLISM OF PREPUBERTAL CHILDREN WITHASTHMA AFTER LONG-TERM TREATMENT WITH INHALED CORTICOSTEROIDS

Little is known about the effect of long-term treatment with inhaled c orticosteroids (ICS) on bone mineral density (BMD) in asthmatic childr en. In the present cross-sectional study BMD, bone metabolism, height, body composition, and bone age were evaluated in 40 prepubertal child ren (21 boys) with asthma, treated with a moderate to high dose of ICS over a period of 3 to 8 years. Body composition and BMD of the lumbar spine and total body were measured by Dual Energy X-ray Absorptiometr y. BMD results were compared with 148 prepubertal healthy children of the same population. Blood samples were taken for the determination of biochemical bone parameters. The asthmatic children had decreased hei ght, lean tissue mass and fat mass, and a delay of bone maturation, in dicating growth retardation. ICS-treated asthma was negatively correla ted with total body BMD in a multiple regression model with adjustment for age, gender, height and weight (P = 0.01). Duration of ICS therap y correlated negatively with total body BMD when it was added to the m odel (P = 0.01). Lumbar spine BMD was not affected by I CS in children with ICS-treated asthma. If age of the asthmatic children was replace d by their bone age in the model, no significant correlation was found between ICS-treated asthma and total body or lumbar spine BMD. The bi ochemical parameters of bone metabolism were within normal limits. In conclusion, children with asthma who have used ICS daily for 3 to 8 ye ars had lower total body BMD than healthy controls. Long-term longitud inal studies are needed to investigate whether these children attain a normal peak bone mass. (C) 1997 Wiley-Liss, Inc.