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Bone health in children and adolescents with steroid-sensitive nephrotic syndrome assessed by DXA and QUS

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Abstract

Background

The management of steroid-sensitive nephrotic syndrome (SSNS) requires treatment with high-dose glucocorticoids (GCs), but GC usage causes the most frequent form of drug-induced osteoporosis. The aim of our study was to evaluate the impact of GCs on bone mineralization in patients with SSNS using two diagnostic tools, dual-energy X-ray densitometry (DXA) and quantitative ultrasound (QUS), and to compare the diagnostic efficacy of these two imaging tools.

Methods

A total of 30 children with SSNS (age 5.20 ± 2.20 years) were evaluated at the start (T0) and after 1 (T1), 2.44 ± 0.75 (T2, 18 patients) and 5.96 ± 2.33 years (T4, 12 patients) of GC treatment. Patients who stopped at T2 were also evaluated at the 1-year timepoint after ceasing GC treatment (T3).

Results

Of the patients assessed at T2, 11 had bone mineralization at the lower limit of normal versus those at T0 and T1, with bone mineralization rescue at the 1-year timepoint after GC discontinuation. At T4, 6/12 patients had densitometric parameters at the lower limit of normal values, and 3/12 patients showed reduced bone mineralization. The parameters derived from measurements of DXA and QUS were significantly related to each timepoint.

Conclusions

Patients with SSNS receiving GC therapy undergo bone status alteration related to the dosage and duration of the therapy. In terms of diagnostic efficacy, DXA and QUS were comparable, indicating that QUS is a reliable tool to evaluate bone health in children with SSNS.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Children’s Hospital Giovanni XXIII, Bari, Italy

    Gabriella Aceto, Olinda D’Addato, Giovanni Messina & Vincenza Carbone

  2. Department of Biomedical Sciences and Human Oncology, Section of Pediatrics, University “A. Moro”, Bari, Italy

    Luciano Cavallo & Maria Felicia Faienza

  3. Department of Basic Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy

    Giacomina Brunetti

Authors
  1. Gabriella Aceto
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  2. Olinda D’Addato
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  3. Giovanni Messina
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  4. Vincenza Carbone
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  5. Luciano Cavallo
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  6. Giacomina Brunetti
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  7. Maria Felicia Faienza
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Correspondence to Giacomina Brunetti.

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Aceto, G., D’Addato, O., Messina, G. et al. Bone health in children and adolescents with steroid-sensitive nephrotic syndrome assessed by DXA and QUS. Pediatr Nephrol 29, 2147–2155 (2014). https://doi.org/10.1007/s00467-014-2834-3

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  • DOI: https://doi.org/10.1007/s00467-014-2834-3

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