Inhaled corticosteroids may have a beneficial effect on bone metabolism in newly diagnosed asthmatic children

• Published in: Pulmonary pharmacology & therapeutics 2011-08, Vol.24 (4), p.414-420
• Main Authors: Stelmach, Iwona, Olszowiec-Chlebna, Malgorzata, Jerzynska, Joanna, Grzelewski, Tomasz, Stelmach, Włodzimierz, Majak, Pawel
• Format: Article
• Language: English
• Subjects: Acetates - therapeutic use; Administration, Inhalation; Adolescent; Asthma; Asthma - drug therapy; Asthma - metabolism; Bone and Bones - metabolism; Bone metabolism; Budesonide - administration & dosage; Child; Child, Preschool; Children; Double-Blind Method; Female; Glucocorticoids - therapeutic use; Humans; Inhaled corticosteroids; Male; Medical Education; Parathyroid Hormone - blood; Phosphorus - blood; Pulmonary/Respiratory; Quinolines - therapeutic use; Vitamin D
• ISSN: 1094-5539; 1522-9629
• DOI: 10.1016/j.pupt.2011.01.004

Abstract Background The adverse effect of inhaled corticosteroids (ICS) treatment on bone metabolism in children with asthma is still controversial, and a possible beneficial effect of vitamin D added to ICS on bone turnover is uncertain. Objective We conducted a randomized, double-blind, parallel-group, 6-month trial to assess the effects of a medium and high dose of ICS and a high-dose ICS with vitamin D on bone metabolism in children with newly diagnosed atopic asthma. Methods 96 children were equally randomized to 4 groups receiving the following doses of inhaled budesonide [μg/day]: 400 (ICS 400 group), 800 (ICS 800 group), 800 with oral vitamin D (ICS 800 with vit D group), and montelukast as a control (control group). Markers of bone production (osteocalcin, alkaline phosphatase) and bone degradation (amino-terminal cross-linked telopeptide of type I collagen – NTx, carboxy-terminal telopeptides of type I collage), and also concentration of 25-hydroxycholecalciferol (25OH D) and calcium–phosphorus balance (calcium, phosphorus, parathormon-PTH) in serum and/or urine were assessed twice: before and after 6 months of treatment. Results We obtained a significant decrease in phosphorus and PTH serum levels in ICS 400 and ICS 800 with vit D groups compared to control group, and a significant decrease of NTx urine level in ICS 800 with vit D group. Conclusions Medium doses of inhaled corticosteroids exert an advantageous effect on bone metabolism in newly diagnosed asthmatic children. Vitamin D together with a high dose of inhaled corticosteroids has a beneficial effect on both calcium–phosphorus balance and collagen turnover.