Longitudinal assessment of bone mineral density in children with chronic asthma.

BACKGROUND: With the emphasis on asthma as a chronic inflammatory process, the management of moderate to severe asthma, even in the pediatric population, has shifted to the regular use of inhaled anti-inflammatory agents, including inhaled corticosteroids. Accompanying the use of these agents has been the precaution that long-term use may have subtle or potential side effects, including growth suppression or decreased bone mineral deposition. OBJECTIVE: We sought to study the effects of inhaled anti-inflammatory agents on bone mineral density accumulation in growing asthmatic children. Included in this report is the longitudinal acquisition of bone mineral density in children with moderate to severe asthma. METHODS: Bone mineral density in normal and asthmatic children was measured longitudinally by dual-energy absorptiometry. Bone densitometry was determined twice over a 7- to 16-month period in 21 asthmatic children and a 13- to 60-month period in 14 normals. These children with two longitudinal visits were compared with a group of 107 normal children who had a single bone mineral density measurement. RESULTS: Nineteen of 21 asthmatic children used regular inhaled corticosteroids during the interval visits. The majority of the asthmatic boys had bone mineral density measurements, at both visits, that were at a higher percentile than normal boys with two visits. Asthmatic girls had bone density measurements at percentiles not significantly different than normal girls with two visits. CONCLUSIONS: The advancement of bone mineral density in asthmatic children provides support for the safety of inhaled anti-inflammatory medications on bone mineral density in children with significant asthma.

Bone mineral density in normal and asthmatic children.

BACKGROUND: The largest increase in bone mass occurs during childhood and adolescence. A subnormal bone mass is associated with increased risk of fracture. Bone mass is influenced by height, age, race, exercise, and stage of puberty. It is adversely affected by chronic disease states and corticosteroid use. We performed a cross-sectional study of bone density in children with moderate to severe asthma who were treated with inhaled corticosteroids, inhaled cromolyn, oral corticosteroids, or a combination of these, and we compared them with normal children. METHODS: A cross-sectional study of bone density, measured either by dual-photon or dual-energy absorptiometry, was performed on 97 normal white and 30 asthmatic white children, aged 5 to 18. Average daily calcium intake, height, weight, and Tanner stage were determined. The total daily and lifetime doses of inhaled corticosteroids in children with asthma were calculated. T tests, multiple regression, chi square analysis, and analysis of covariance were performed. RESULTS: No significant difference in bone density was demonstrated between children with asthma and normal control subjects. No measure (including calcium intake, Tanner stage, daily or lifetime inhaled corticosteroid dose, or duration of illness), except for height and age, provided a significant contribution to the explanation of bone density in children with asthma. CONCLUSION: Children and adolescents with moderate to severe asthma, including those treated with inhaled corticosteroids, do not appear to have adversely affected bone mass. There was, however, the possibility of a type II error in this study because of the sample size.