Corticosteroid use and bone mineral accretion in children with asthma: Effect modification by vitamin D
The Journal of Allergy and Clinical Immunology, 05/21/2012
Tse SM et al. – Vitamin D levels significantly modified the effect of oral corticosteroids (OCSs) on bone mineral accretion (BMA) in boys.Methods
- Children aged 5 to 12years with mild–to–moderate asthma who participated in the Childhood Asthma Management Program were followed for a mean of 4.3years.
- 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 4years’ follow–up–BMD at baseline)/4years].
- 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).