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Randomized Controlled Trial
. 2012 Jul;130(1):53-60.e4.
doi: 10.1016/j.jaci.2012.04.005. Epub 2012 May 16.

Corticosteroid use and bone mineral accretion in children with asthma: effect modification by vitamin D

Sze Man Tse  1 , H William Kelly, Augusto A Litonjua, Mark L Van Natta, Scott T Weiss, Kelan G Tantisira; Childhood Asthma Management Program Research Group
Collaborators, Affiliations
Randomized Controlled Trial

Corticosteroid use and bone mineral accretion in children with asthma: effect modification by vitamin D

Sze Man Tse et al. J Allergy Clin Immunol. 2012 Jul.

Abstract

Background: The adverse effects of corticosteroids on bone mineral accretion (BMA) have been well documented. Vitamin D insufficiency, a prevalent condition in the pediatric population, has also been associated with decreased bone mineral density (BMD).

Objective: We sought to determine whether children with asthma who have lower vitamin D levels are more susceptible to the negative effects of corticosteroids on BMD over time.

Methods: Children aged 5 to 12 years with mild-to-moderate asthma who participated in the Childhood Asthma Management Program were followed for a mean of 4.3 years. Total doses of inhaled corticosteroids and oral corticosteroids (OCSs) were recorded, serum 25-hydroxyvitamin D3 levels were measured at the beginning of the trial, and serial dual-energy x-ray absorptiometry scans of the lumbar spine were performed. Annual BMA rates were defined as follows: [(BMD at 4 years' follow-up - BMD at baseline)/4 years].

Results: BMA was calculated for 780 subjects. In boys baseline vitamin D levels significantly modified the relationship between OCSs and BMA (vitamin D × OCS interaction, P= .023). Stratification by vitamin D levels showed a decrease in BMA with increased use of OCSs in vitamin D-insufficient boys only (P< .001). Compared with vitamin D-sufficient boys, vitamin D-insufficient boys exposed to more than 2 courses of OCSs per year had twice the decrease in BMA rate (relative to boys who were OCS unexposed).

Conclusions: Vitamin D levels significantly modified the effect of OCSs on BMA in boys. Further research is needed to examine whether vitamin D supplementation in children with poorly controlled asthma might confer benefits to bone health.

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Conflict of interest statement

The authors have no financial disclosures and conflict of interest to declare.

Figures

Figure 1
Figure 1
Difference in BMA between OCS-exposed and OCS-unexposed in boys, by category of OCS exposure and vitamin D sufficiency status. Vitamin D insufficient boys who were exposed to more than 2 OCS courses per year had twice the difference in BMA compared to the vitamin D sufficient boys.
See this image and copyright information in PMC

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