Publication: İnhale kortikosteroidlerle tedavi edilen orta ve ağır astımlı çocuklarda kemik mineral yoğunluğunun değerlendirilmesi
Abstract
inhale kortikosteroidler (İKS) orta ve şiddetli astımı olan hastaların tedavisinde oldukça yaygın olarak kullanılmaktadır. Bununla birlikte uzun süreli İKS tedavisinin kemik metabolizması üzerine olan muhtemel olumsuz etkileri ile ilgili kaygılar vardır. Çalışmamızda 24-72 ay süresince günde ortalama 455 $\mu$g (200-1000 $\mu$g) İKS kullanan 6-14 yaşları arasındaki 30 astımlı çocuk ile aynı yaş ve cinsiyetteki 30 sağlıklı çocuktan oluşan kontrol grubunun kemik mineral yoğunlukları (KMY), dual photon absorptiometri (DPA) kullanılarak ölçülmüştür. Hasta grubu ile kontrol grubu arasında total KMY, vertebra, pelvis, kol ve kaburga KMY açısından farklılık saptanmamakla birlikte, bacak ve gövde KMY hasta grubunda istatistiksel anlamlı olarak düşük bulunmuştur (sırasıyla p=0.003 ve p=0.02). Ayrıca astımlı çocuklarda boy, kontrol grundan istatistiksel anlamlı olarak düşüktür (p=0.001). Her iki grup arasında diyetlerindeki günlük kalsiyum miktarı arasında farklılık saptanmamakla birlikte, astımlı çocuklar günlük önerilen edilen miktarın sadece %66'sını, kontrol grubundaki çocuklar ise %59'unu almaktadır. Sonuç olarak bizim çalışma grubumuzdaki astımlı çocukların boylarının ve bazı bölgesel kemik mineral yoğunluklarının düşük olması kısmen düşük kalsiyum alımı ile ilişkili olabilir. Puberte öncesi ve puberte döneminde edinilen maksimum KMY erişkin dönemde osteoporoz ve kemik kırık riskinin belirlenmesinde önemli olabilir. İKS kullanan hastalarda yeterli kalsiyum ve D vitamini alımının sağlanması, büyümenin yakından izlenmesi ve kemik mineral yoğunluğunun ölçülmesi kemik metabolizması üzerindeki muhtemel olumsuz etkilerin saptanmasına ve gerekli önlemlerin alınmasına yardımcı olabilir.
Inhaled corticosteroids (ICS) are commonly used for patients with moderate to severe asthma. However, potential adverse effects on bone turnover is one of the greatest concerns of long-term ICS treatment. In the present study bone mineral density (BMD) was measured in 30 children (6-14 years) treated with ICS at a mean daily dose of 455 $\mu$g/day (200-1000) for 24-72 months and in 30 age-sex matched healthy controls using dual photon absorptiometry (DPA), There was no significant difference between asthmatics and controls for total BMD, spine, pelvis, arm and rib BMD. However leg and trunk BMD measurements were significantly lower in the asthmatic group (p=0.003 and p=0.02 respectively). Height in asthmatic children was significantly lower than in the control group (p=0.001). Although there was no significant difference in the daily calcium intake in both groups, this value was only 66 percent of the recommended daily allowance of calcium (RDA) in asthmatic group and 59 percent of the RDA in the control group. In conclusion in our study, decreased height and some regional BMD measurements in the asthmatic children may be partly related to low calcium intake. Peak bone density attained during prepubertal and pubertal years may be a critical determinant of fracture risk in adulthood. Maintainance of adequate calcium and vitamin D intake, close monitoring of growth, and bone mineral density measurement in asthmatic children receiving ICS agents may be helpful in determining and treating the possible adverse effect of the treatment on bone metabolism.
Inhaled corticosteroids (ICS) are commonly used for patients with moderate to severe asthma. However, potential adverse effects on bone turnover is one of the greatest concerns of long-term ICS treatment. In the present study bone mineral density (BMD) was measured in 30 children (6-14 years) treated with ICS at a mean daily dose of 455 $\mu$g/day (200-1000) for 24-72 months and in 30 age-sex matched healthy controls using dual photon absorptiometry (DPA), There was no significant difference between asthmatics and controls for total BMD, spine, pelvis, arm and rib BMD. However leg and trunk BMD measurements were significantly lower in the asthmatic group (p=0.003 and p=0.02 respectively). Height in asthmatic children was significantly lower than in the control group (p=0.001). Although there was no significant difference in the daily calcium intake in both groups, this value was only 66 percent of the recommended daily allowance of calcium (RDA) in asthmatic group and 59 percent of the RDA in the control group. In conclusion in our study, decreased height and some regional BMD measurements in the asthmatic children may be partly related to low calcium intake. Peak bone density attained during prepubertal and pubertal years may be a critical determinant of fracture risk in adulthood. Maintainance of adequate calcium and vitamin D intake, close monitoring of growth, and bone mineral density measurement in asthmatic children receiving ICS agents may be helpful in determining and treating the possible adverse effect of the treatment on bone metabolism.