The Effects of 1alpha-(OH)D3 and Pamidronate on Steroid Induced Osteoporosis (SIO) in Children with Nephrotic Syndrome (NS)

ABSTRACT

PURPOSE: Corticosteroid has been used as the mainstay therapy of childhood NS. But SIO is one of the serious complications of long-term steroid therapy, especially in growing children. Recently calcium, calcitonin, PTH, vitamin D and bisphosphonate has been used to treat or prevent SIO in adult, which is rare in children with NS. We studied the effect of 1alpha-(OH)D3 and Pamidronate on SIO using dual energy X-ray absorptiometry (DEXA). PATIENTS AND METHODS: We studied thirty patients who admitted in the Dept. of Pediatrics of Kyung Hee Medical Hospital with NS. All patients was received longterm steroid therapy. There was no history of bone, liver, or endocrine disease. The samples, serum protein, albumin, BUN, creatinine, calcium, phosphorus, and BMD were obtained before and the six months after the dose of 1alpha-(OH)D3 and Pamidronate, respectively. RESULTS: The mean age was 6.9+/-3.3 and 6.5+/-2.5 years old. The mean duration of steroid therapy was 28.8+/-1.8 and 27.6+/- 1.0 months. The changes of serum protein, albumin, BUN, creatinine, calcium and phosphorus level between pre-treatment and post-treatment did not show statistical significance in both 1alpha-(OH)D3 and Pamidronate treatment group. However, BMD was increased in both from 0.472+/-0.12 and 0.457+/-0.10 g/cm2 to 0.533+/-0.12 and 0.529+/-0.09 g/cm2 after treatment. (P<0.05). CONCLUSION: Both 1alpha-(OH)D3 and Pamidronate appears to be effective in treating and preventing SIO in children with nephrotic syndrome requiring long-term steroid therapy.