The change in bone mineral density in children with nephrotic syndrome after long-term steroid treatment

The aim of the study was evaluation of bone mineral density (BMD) in children and adolescents with nephrotic syndrome (NS). Lumbar spine BMD was measured with dual energy X-ray absorptiometry (DXA) in 30 patients with NS. The data were expressed as medians (Me) and 25th and 75th centiles and were analyzed with non-parametric tests using SPSS-13 for Windows software. The BMD Z-score was –0,5 (–2,3; –1,05; 0,02; 1,3) [Me (min; 25th; 75th; max)] SD. Low BMD compared to normal value for the same age (BMD Z-score less than or equal to –2 SD) was found in 2 adolescents. Non-severe decrease in BMD (Z-score less than or equal to –1 SD, but above –2 SD) was found in 26,7% (8/30) patients. There was a significant correlation between BMD and patients age ( r = 0,868, p = 0,001) and between BMC and age (r = 0,916, p = 0.0001). Patients with decreased BMD had steroid dependence (p = 0,026) more often than patients with the Z-score above –1 SD. We divided our patients into 4 groups according to cluster analysis. The cluster group of patients with maximum Z-score had minimal period after cessation of steroid therapy and regular prophylactic therapy with low-dose vitamin D plus calcium. No correlation was found between BMD Z-score and duration of steroid treatment or cumulative prednisolone exposure. Our results show that BMD is not significantly decreased in children with NS. Steroid dependence is a risk factor for decrease in BMD. Regular prophylactic with low-dose of vitamin D plus calcium can prevent osteoporosis in children with NS.

нефротический синдром, минеральная плотность кости, глюкокортикоиды, дети, двухэнергетическая рентгеновская абсорбциометрия, nephrotic syndrome, bone mineral density, corticosteroids, children, dual energy X-ray absorptiometry

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