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Prevention of steroid-induced low bone mineral density in children with renal diseases: a systematic review.

Abstract

BACKGROUND

Children with renal diseases who are treated with glucocorticoids are at increased risk of developing osteoporosis and fractures. However, there is no common strategy for prevention of corticosteroid-induced osteoporosis. The present systematic review was performed to determine whether prevention of bone loss by calcium (Ca), vitamin D (vit D) and/or bisphosphonates is justified, safe and efficacious in children treated with steroids for various renal diseases.

METHODS

DATA SOURCES

Medline, Embase, Central were searched from 1961 up to 2012. Randomized controlled trials (RCTs) and observational studies concerning children ≤18 years with renal diseases requiring steroids were included.

RESULTS

The search strategy retrieved 2482 studies. Four RCTs including 166 patients and one observational study including 100 children met our eligibility criteria. One RCT and the observational study concerned treatment with Ca/vit D, one RCT with bisphosphonates and two RCTs with a combination of both therapies. All described a significant improvement in bone mineral density (BMD) in the treatment group compared with the control group.

CONCLUSIONS

 Ca combined with vit D is recommended to prevent bone disease in children with renal diseases treated with steroids. Because of side effects, bisphosphonates should be reserved for the treatment of severe osteoporosis when Ca and/or vit D supplementation has failed.

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  • Authors+Show Affiliations

    ,

    Department of Pediatric Nephrology, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.

    , , , , ,

    Source

    MeSH

    Bone Density
    Bone Density Conservation Agents
    Bone Diseases
    Calcium, Dietary
    Dietary Supplements
    Humans
    Kidney Diseases
    Meta-Analysis as Topic
    Randomized Controlled Trials as Topic
    Steroids
    Vitamin D

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    23640430

    Citation

    Gruppen, Mariken P., et al. "Prevention of Steroid-induced Low Bone Mineral Density in Children With Renal Diseases: a Systematic Review." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 28, no. 8, 2013, pp. 2099-106.
    Gruppen MP, Davin JC, Oosterveld MJ, et al. Prevention of steroid-induced low bone mineral density in children with renal diseases: a systematic review. Nephrol Dial Transplant. 2013;28(8):2099-106.
    Gruppen, M. P., Davin, J. C., Oosterveld, M. J., Schreuder, M. F., Dorresteijn, E. M., Kramer, S. P., & Bouts, A. H. (2013). Prevention of steroid-induced low bone mineral density in children with renal diseases: a systematic review. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 28(8), pp. 2099-106. doi:10.1093/ndt/gft090.
    Gruppen MP, et al. Prevention of Steroid-induced Low Bone Mineral Density in Children With Renal Diseases: a Systematic Review. Nephrol Dial Transplant. 2013;28(8):2099-106. PubMed PMID: 23640430.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prevention of steroid-induced low bone mineral density in children with renal diseases: a systematic review. AU - Gruppen,Mariken P, AU - Davin,Jean-Claude, AU - Oosterveld,Michiel J, AU - Schreuder,Michiel F, AU - Dorresteijn,Eiske M, AU - Kramer,Sharon P, AU - Bouts,Antonia H, Y1 - 2013/05/02/ PY - 2013/5/4/entrez PY - 2013/5/4/pubmed PY - 2014/4/4/medline KW - bisphosphonates KW - calcium/vitamin D KW - osteoporosis KW - renal diseases KW - steroids SP - 2099 EP - 106 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 28 IS - 8 N2 - BACKGROUND: Children with renal diseases who are treated with glucocorticoids are at increased risk of developing osteoporosis and fractures. However, there is no common strategy for prevention of corticosteroid-induced osteoporosis. The present systematic review was performed to determine whether prevention of bone loss by calcium (Ca), vitamin D (vit D) and/or bisphosphonates is justified, safe and efficacious in children treated with steroids for various renal diseases. METHODS: DATA SOURCES: Medline, Embase, Central were searched from 1961 up to 2012. Randomized controlled trials (RCTs) and observational studies concerning children ≤18 years with renal diseases requiring steroids were included. RESULTS: The search strategy retrieved 2482 studies. Four RCTs including 166 patients and one observational study including 100 children met our eligibility criteria. One RCT and the observational study concerned treatment with Ca/vit D, one RCT with bisphosphonates and two RCTs with a combination of both therapies. All described a significant improvement in bone mineral density (BMD) in the treatment group compared with the control group. CONCLUSIONS:  Ca combined with vit D is recommended to prevent bone disease in children with renal diseases treated with steroids. Because of side effects, bisphosphonates should be reserved for the treatment of severe osteoporosis when Ca and/or vit D supplementation has failed. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/23640430/full_citation L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gft090 DB - PRIME DP - Unbound Medicine ER -