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Journal of the Korean Society of Pediatric Nephrology 2004;8(1): 33-42.
신증후군 환아에서 스테로이드 유발 대사성 골질환에 대한 Alendronate의 치료 효과
이지은, 이현옥, 백경훈, 이숙향, 진동규
1인하대학교 의과대학 소아과학교실
2숙명여자대학교 임상약학대학원 임상약학과
3성균관대학교 의과대학 삼성서울병원 소아과
4숙명여자대학교 임상약학대학원 임상약학과
5성균관대학교 의과대학 삼성서울병원 소아과
Therapeutic Efficacy of Alendronate for Glucocorticoid Induced Metabolic Bone Disease in Children with Nephrotic Syndrome
Ji-Eun Lee, Hyun-Ok Lee, Kyung-Hoon Paik, Suk-Hyang Lee, Dong-Kyu Jin
1Department of Pediatrics, College of Medicine, Inha University
2Department of Clinical Pharmacology, Graduate School of Clinical Pharmacy, Sookmyung Women's University
3Department of Pediatrics, College of Medicine, Sungkyunkwan University, Samsung Medical Center
4Department of Clinical Pharmacology, Graduate School of Clinical Pharmacy, Sookmyung Women's University
5Department of Pediatrics, College of Medicine, Sungkyunkwan University, Samsung Medical Center
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ABSTRACT
Purpose : Children with nephrotic syndrome(NS) are under high risk for metabolic bone disease(MBD) as a complication of long-term glucocorticoid therapy. We prospectively evaluated the effect of oral bisphosphonate(alendronate) therapy in children with NS, which has proven efficacy in adult patients with glucocorticoid induced MBD.
Methods : Among 58 children with NS, aged 5 to 8 years and haying a disease duration of more than 2 years, 30(51.7%) were enrolled to meet the selection criteria, less than -1.0 Z-scores of lumbar spine bone mineral density(BMD) by dual energy X-ray absorptiometry (DEXA). These 30 children were divided into three groups and each were assigned to receive alendronate, calcitriol, and no-medication, respectively for one year. Lumbar spine BMD was followed up every 6 months and the biochemical indexes were measured before and 1 year after the treatment. There were no significant difference among groups with respect to the average age, the initial BMD, and the cumulative steroid doses. Analysis of the treatment efficacy was done by the % change of BMD and by the changes in Z-scores of lumbar spine BMD.
Results : Mean age and disease duration of patients at the initial lumbar spine BMD evaluation was $7.4{pm}1.7$ years and $2.2{pm}1.2$ years, respectively. Twenty-three of 30 children(76%) had osteopenia, and seven(23%) had osteoporosis. There was no difference in the biochemical values among the groups, before and 1 year after the treatment(P<0.05). Twenty two children(73.3%) with frequent relapsing or steroid dependant NS had more frequent MBD, compared to the 8 children(26.6%) with infrequent relapsing NS. The one year % changes of BMD were 8.56 in alendronate group, 5.79 in calcitriol group, and 1.9 in no-medication group. The changes in Z-score of lumbar spine BMD increased in the alendronate group and the calcitriol group, but not in the no-medication group. One year % changes of BMD were different among groups(P=0.0002). Significant differences were found between the alendronate and the no-medication group, and between the calcitriol and the no-medication group(P<0.05). There was no difference between the alendronate and the calcitriol group. No serious adverse effect was observed in the alendronate group.
Conclusion : Children with NS receiving high dose steroids are under the high risk of BMD and should undergo regular BMD evaluation. Z-score of lumbar spine BMD was a useful parameter in diagnosing low bone mass in children. Alendronate weekly oral therapy was effective and relatively safe in increasing the lumbar spine BMD in children with NS having steroid induced MBD.
Key words: Alendronate | Nephrotic syndrome | Glucocorticoid induced metabolic bone disease | Bone mineral density | Z-score
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