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Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation.
J Pediatr Gastroenterol Nutr. 2011 Sep; 53(3):326-32.JP

Abstract

OBJECTIVES

The aim of the study was to examine the association of corticosteroid exposure and other skeletal risk factors with bone mineral density (BMD) and fractures following pediatric liver transplantation (LT) at a large single center.

PATIENTS AND METHODS

Lumbar spine BMD, measured using dual-energy x-ray absorptiometry (DXA), was corrected for bone age in 52 ambulatory children ages 4 to 18 years, at least 1 year post-LT. Potential risk factors for skeletal health such as corticosteroid exposure, dietary and lifestyle factors, and growth and fracture occurrence, were related to BMD using univariate and multivariate regression analyses.

RESULTS

The prevalence of low BMD (z score <-2) and post-LT fractures was 3 of 52 (5.8%) and 11 of 52 (21%), respectively. Univariate analysis revealed age >10 years at LT and body mass index (BMI) < 85th percentile at time of DXA were significantly associated with BMD (both P = 0.02). BMD did not correlate with corticosteroid dosage in the first year post-LT, the year before DXA or cumulative lifetime exposure. A cholestatic primary LT indication, acute rejection episodes, and fractures post-LT were not associated with BMD. Extracurricular physical activity, vitamin D, and calcium intake were not associated with BMD or fractures. Multivariate linear regression revealed increased time post-LT (P = 0.04) and higher BMI z score at time of DXA (P = 0.02) as the strongest independent variables associated with greater BMD.

CONCLUSIONS

Neither corticosteroid exposure nor a cholestatic primary indication for LT influenced BMD, which was largely normal in this ambulatory group. Children and adolescents undergoing LT after the age of 10 years and those with low BMI post-LT may be at greatest risk of poor skeletal health later in life, and thus a potential target patient population to benefit from preventive interventions.

Authors+Show Affiliations

SickKids Transplant Centre, the Hospital for Sick Children, University of Toronto, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21629126

Citation

Nightingale, Scott, et al. "Corticosteroid Exposure Not Associated With Long-term Bone Mineral Density in Pediatric Liver Transplantation." Journal of Pediatric Gastroenterology and Nutrition, vol. 53, no. 3, 2011, pp. 326-32.
Nightingale S, McEwan-Jackson FD, Hawker GA, et al. Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation. J Pediatr Gastroenterol Nutr. 2011;53(3):326-32.
Nightingale, S., McEwan-Jackson, F. D., Hawker, G. A., Macarthur, C., Khambalia, A. Z., Lo, L., Fecteau, A., & Ng, V. L. (2011). Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation. Journal of Pediatric Gastroenterology and Nutrition, 53(3), 326-32. https://doi.org/10.1097/MPG.0b013e3182258656
Nightingale S, et al. Corticosteroid Exposure Not Associated With Long-term Bone Mineral Density in Pediatric Liver Transplantation. J Pediatr Gastroenterol Nutr. 2011;53(3):326-32. PubMed PMID: 21629126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation. AU - Nightingale,Scott, AU - McEwan-Jackson,Fiona D, AU - Hawker,Gillian A, AU - Macarthur,Colin, AU - Khambalia,Amina Z, AU - Lo,Lisha, AU - Fecteau,Annie, AU - Ng,Vicky L, PY - 2011/6/2/entrez PY - 2011/6/2/pubmed PY - 2011/12/23/medline SP - 326 EP - 32 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 53 IS - 3 N2 - OBJECTIVES: The aim of the study was to examine the association of corticosteroid exposure and other skeletal risk factors with bone mineral density (BMD) and fractures following pediatric liver transplantation (LT) at a large single center. PATIENTS AND METHODS: Lumbar spine BMD, measured using dual-energy x-ray absorptiometry (DXA), was corrected for bone age in 52 ambulatory children ages 4 to 18 years, at least 1 year post-LT. Potential risk factors for skeletal health such as corticosteroid exposure, dietary and lifestyle factors, and growth and fracture occurrence, were related to BMD using univariate and multivariate regression analyses. RESULTS: The prevalence of low BMD (z score <-2) and post-LT fractures was 3 of 52 (5.8%) and 11 of 52 (21%), respectively. Univariate analysis revealed age >10 years at LT and body mass index (BMI) < 85th percentile at time of DXA were significantly associated with BMD (both P = 0.02). BMD did not correlate with corticosteroid dosage in the first year post-LT, the year before DXA or cumulative lifetime exposure. A cholestatic primary LT indication, acute rejection episodes, and fractures post-LT were not associated with BMD. Extracurricular physical activity, vitamin D, and calcium intake were not associated with BMD or fractures. Multivariate linear regression revealed increased time post-LT (P = 0.04) and higher BMI z score at time of DXA (P = 0.02) as the strongest independent variables associated with greater BMD. CONCLUSIONS: Neither corticosteroid exposure nor a cholestatic primary indication for LT influenced BMD, which was largely normal in this ambulatory group. Children and adolescents undergoing LT after the age of 10 years and those with low BMI post-LT may be at greatest risk of poor skeletal health later in life, and thus a potential target patient population to benefit from preventive interventions. SN - 1536-4801 UR - https://www.unboundmedicine.com/medline/citation/21629126/Corticosteroid_exposure_not_associated_with_long_term_bone_mineral_density_in_pediatric_liver_transplantation_ L2 - https://doi.org/10.1097/MPG.0b013e3182258656 DB - PRIME DP - Unbound Medicine ER -