Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Aug;44(1):47-54.
doi: 10.1016/j.semarthrit.2014.02.002. Epub 2014 Feb 11.

A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children

Karen E Hansen  1 , Brian Kleker  2 , Nasia Safdar  3 , Christie M Bartels  4
Affiliations
Meta-Analysis

A systematic review and meta-analysis of glucocorticoid-induced osteoporosis in children

Karen E Hansen et al. Semin Arthritis Rheum. 2014 Aug.

Abstract

Objective: To summarize the published effects of systemic glucocorticoid therapy on bone mineral density (BMD) and fractures in children.

Methods: We performed a systematic review and meta-analysis of existing literature, using Medline, CINAHL, and Cochrane databases to identify studies of BMD or fractures in children ≤18 years taking systemic glucocorticoid therapy. We excluded studies of inhaled glucocorticoids, chemotherapy, and organ transplantation. Two authors reviewed abstracts for inclusion, read full-text articles to extract data, and rated each study using the Downs-Black scale.

Results: A total of 16 studies met eligibility criteria, including 10 BMD (287 children) and six fracture (37,819 children) studies. Spine BMD was significantly lower (-0.18; 95% CI = -0.25; -0.10 g/cm(2)) in children taking glucocorticoid therapy, compared to age- and gender-matched healthy controls. Spine BMD was also lower (-0.14; 95% CI = -0.27; 0.00 g/cm(2)) in children taking glucocorticoids, compared to children with the same disease not taking glucocorticoids. Incident clinical fracture rates varied from 2% to 33%. Morphometric vertebral fracture incidence ranged from 6% to 10%, and prevalence was 29-45%.

Conclusion: Published data suggest that children treated with glucocorticoid therapy have lower spine BMD compared to healthy children. Whether children receiving glucocorticoid therapy have lower spine BMD compared to children with milder disease not requiring such therapy is not certain. Clinical and morphometric vertebral fractures are common, although only one study assessed fracture rates in healthy controls. Additional well-designed, prospective studies are needed to evaluate the skeletal effects of glucocorticoid therapy in children.

Keywords: Bone mineral density; Children; Fracture; Glucocorticoid therapy; Meta-analysis; Systematic review.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Summary of articles reviewed.
Fig. 2
Fig. 2
Difference in spine bone mineral density, cases and controls with same disease.
Fig. 3
Fig. 3
Difference in spine bone mineral density, cases and healthy controls.
Fig. 4
Fig. 4
Prospective changes in spine BMD in children taking glucocorticoid therapy.
Fig. 5
Fig. 5
Prospective changes in spine Z-score in children taking glucocorticoid therapy.
See this image and copyright information in PMC

References

    1. Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Miner Res. 2000;15:993–1000. - PubMed
    1. Chappard D, Legrand E, Basle MF, Fromont P, Racineux JL, Rebel A, et al. Altered trabecular architecture induced by corticosteroids: a bone histomorphometric study. J Bone Miner Res. 1996;11:676–685. - PubMed
    1. Dalle Carbonare L, Arlot ME, Chavassieux PM, Roux JP, Portero NR, Meunier PJ. Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res. 2001;16:97–103. - PubMed
    1. Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC. Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest. 1998;102:274–282. - PMC - PubMed
    1. van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. 2002;13:777–787. - PubMed

Publication types

Substances