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Monday, June 7, 2010

Bone mineral density impaired in children receiving continuous inhaled corticosteroids

Reduced growth induced by inhaled corticosteroid (ICS) use in children with asthma has been, and continues to be, a focus for researchers. Most of the research has been of short duration, and reported no significant differences observed between ICS-treated children and children treated with non-steroidal therapies, such as nedocromil. Moreover, bone mineral density has never been measured in a trial.

The recent online publication by Turpeinen et al. (Pediatric Research 2010, doi: 10.1203/PDR.0b013e69e36), at Helsinki University Hospital, presents findings from the first long-term controlled trial to address the clinical impact of ICS therapy on bone mineral density (BMD). The authors conduct an 18-month blinded randomized trial with three parallel treatment arms: 1) step down, high to moderate budesonide, followed by low-dose maintainace for 12 months; 2) step down, high to moderate budesonide, followed by placebo for a year, with PRN budesonide for worsening; and 3) disodium cromoglycate (DSCG) for all 18 months.

Turpeinen et al. find that BMD was significantly decreased across any BUD treatment as compared to DSCG treatment after 6 months, but more in the continuous BUD group. The difference between all three treatment groups was significant after 12 and 18 months, by pairwise comparison. Overall, all subjects had increased BMD and height across the duration of the study, with the BUD treatment group having the smallest incremental change. They conclude by suggesting that height could be used clinically to monitor ICS effects on bone.

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