Effect of inhaled budesonide treatment on bone density in children with asthma

Yıl 2005, Cilt: 36 Sayı: 4, 185 - 188, 01.05.2005

Serdar Yılmaz Gülnur Tokuç Sedat Öktem Nadir Girit

Öz

Objective: To asses the effect of inhaled budesonide on the bone density and bone metabolism in children with asthma. Material and Methods: Prospective study was conducted in 126 children with asthma aged 5 to 14 years, selected from the pediatric outpatient clinic. Two study group were assembled: 86 asthmatic children treated with inhaled budesonide for over 6 months (Group I); and 40 asthmatic children not treated with inhaled corticosteroids (Group II). Serum Ca, P, ALP and bone density was measured. Results: In these two groups studied (I and II) calcium serum levels were 9.20.7; 9.70.5 mg/dl, respectively; phosphorus levels were 4.21.1; 4.60.8 mg/dl, alkaline phosphatase levels were 415108; 402112 U/L, bone density levels were 0.89 0.09; 0.88 0.07 g/cm2, respectively. No statistically significant differences were observed between the two groups. Conclusion: There is no evidence in our study that inhaled budesonide mean 256102 mcg/day and 17.8±11 month duration has an adverse effect on bone density.

Anahtar Kelimeler

Budesonide, Bone Density, Asthma, Child, Prospective Studies

Astımlı çocuklarda inhale budesonid tedavisinin kemik dansitesi üzerine etkisi

Öz

Amaç: Astımlı çocuklarda inhale budesonid'in kemik dansitesi ve kemik metabolizması üzerine olan etkisini değerlendirmek. Gereç ve Yöntem: Prospektif çalışmamıza, polikliniğimizde astım tanısı ile izlenen 5-14 yaşlar arasındaki çocuklardan 126'sı dahil edildi. Hastalar 6 aydan uzun süre inhale budesonid alan 86 astımlı çocuk (Grup I); ve inhale steroid kullanmayan 40 astımlı çocuk (Grup II) olarak 2 gruba ayrıldı. Hastaların serum Ca, P, ALP ve kemik dansitesi ölçüldü. Bulgular: Çalışılan 2 grubun serum kalsiyum değerleri sırasıyla 9.20.7; 9.70.5 mg/dl, fosfor değerleri 4.21.1; 4.60.8 mg/dl, alkalen fosfataz değerleri 415108; 402112 U/L, kemik dansite değerleri 0.89 0.09; 0.88 0.07 g/cm2 idi. İki grup arasında istatistiksel bir fark saptanmadı. Sonuç: Çalışmamızda ortalama 256102 mcg/gün ve 17.811 ay süre ile kullanılan budesonidin kemik dansitesi üzerine olumsuz etkisi saptanmadı.

Anahtar Kelimeler

Budesonid, Kemik yoğunluğu, Astım, Çocuk, İleriye dönük çalışma

Kaynakça

• 1.König P, Hillman LCervente CI. Bone metabolism in children with asthma treated with inhaled beclamethasone dipropionate. J Pediatr 1993; 122:219-26
• 2.Boulet LP, Giguera MC, et al. Effects of long term use of high dose inhaled steroids on bone density and calcium metabolism. J Allergy Clin Immun 1994; 94:796-803
• 3.Hanania NA, Chapman KR, et al. Dose related decrease in bone density among asthmatic patients treated with inhaled corticosteroids. J Allergy Clin Immun 1996; 96:571-79
• 4.Baraldi E, Bollini MC, et al. Effects of beclamethasone dipropionate on bone mineral content assessed by X-ray densitometry in asthmatic children; a longitudinal evaluation. Eur Respir J 1994; 7:710-4
• 5.Sorva R, Turpelnen M, et al. Effects of inhaled budesonide on serum markers of bone metabolism in children with asthma. J Allergy Clin Immun 1992; 90:808-15
• 6.Kannisto S, Korppi M, Arikoski P, et al
• Biochemical markers of bone metabolism in relation to adrenocortical and growth suppression during the initiation phase of inhaled steroid therapy
• Pediatr Res 2002; 52:258-62
• 7.Plebani M, Bernardi D, et al. New and traditional serum markers of bone metabolism. Clin Biochem 1996; 29:67-72
• 8.Hodkinson A, Thomson T. Measurement of fasting urinary hydroxyproline /creatinine ratio in normal adults and its variation with age and sex. J Clin Pathol 1982; 35:807-11
• 9.Kaniş JA. Assesment of bone mass and osteoporosis. Osteoporosis. Revised edition. London 1995; 114-147
• 10.Blake GM, Fogelman I. Bone Densitometry, X- ray and Quantitative Ultrasound. In: Geusens P (ed). Osteoporosis in clinical practice. London 1998;41-48
• 11.Geusens P. Dual Energy X-ray Absorbtiometry in Daily Clinical Practice. In: Geusens P(ed). Osteoporosis in clinical practice. London 1998;59-65
• 12.Cooper C. Rational and clinical indications for bone density measurement. Osteopor Int Suppl 1996,2:56-8
• 13.Paoli VM, Gomez EM, Valeri E, Salinas R, Bellabarba GA. Effect ofbudesonide on bone density and metabolism in asthmatic children. Salud Publica Mex. 2000; 42(4): 309-14
• 14.Biochemical markers of bone metabolism and calciuria with inhaled budesonide therapy. Akil I, Yüksel H, Urk V, Var A, Onur E. Pediatr Nephrol
• 2004; 19(5):511-5
• 15.Agertoft L, Pedersen S. Bone mineral density in children with treatmen asthma receiving long term with inhaled budesonide. Am J Respir Crit Care 1998; 157:178-183
• 16.Russel JH, fanice AD, James P, et al
• Crosssectional study of bone density in asthmatic children. Pediatr Pulmonol 1995; 20:189-192
• 17.Bahçeciler NN, Sezgin G, Nursoy MA, Barlan IB, Basoran MM Inhaled corticosteroids and bone density of children with asthma. 2002;39(2):151-7
• 18.Altintas DU, Karakoc GB, Can S, Yılmaz M, Kendirli SG. The effects of long term use of inhaled corticosteroids on linear growth, adrenal function and bone mineral density in children
• 2005;33(4):204-9
• 19.Packe GE, Douglas JG, et al. Bone density in asthmatic patients taking high dose inhaled beclamethasone and intermittent sistemic steroids
• Thorax 1992;47:414-7.