Efficacy of Pamidronate in Nephropathic Children with Ongoing Long Term Corticosteroid Therapy

Hong, Hyun-Kee; Kim, Eun-Seong; Kim, Sung-Do; Cho, Byoung-Soo

J Korean Soc Pediatr Nephrol > Volume 8(1); 2004 > Article

J Korean Soc Pediatr Nephrol 2004;8(1): 43-50.

장기 스테로이드 치료요법 중인 신질환 환자에서 Pamidronate의 효과

홍현기, 김은성, 김성도, 조병수

¹경희대학교 의과대학 소아과교실
²경희대학교 의과대학 소아과교실
³경희대학교 의과대학 동서신장병연구소
⁴경희대학교 의과대학 동서신장병연구소

Efficacy of Pamidronate in Nephropathic Children with Ongoing Long Term Corticosteroid Therapy

Hyun-Kee Hong, Eun-Seong Kim, Sung-Do Kim, Byoung-Soo Cho

¹Department of Pediatrics, College of Medicine, Kyunghee University
²Department of Pediatrics, College of Medicine, Kyunghee University
³East-West Kidney Disease Research Institute, College of Medicine, Kyunghee University
⁴East-West Kidney Disease Research Institute, College of Medicine, Kyunghee University

ABSTRACT

Background : Steroid-induced osteoporosis(SIO) is one of the serious complications of long-term steroid therapy, especially in growing children. Recently bisphosphonates have been used to treat or prevent SIO in adult, which is rare in children with glomerular diseases. We studied the effect of pamidronate on SIO using dual energy X-ray absorptiometry and biochemical markers of bone turnover.
Methods : Forty four children receiving moderate-to-high doses of steroids were enrolled. They had no history of bone, liver, or endocrine disease. Patients were stratified by their baseline bone mineral density(BMD) findings. All patients received corticosteroids for 3 month and oral calcium supplementation(500 mg/day) daily. Among them, 28 patients were treated with placebo and 16 were treated with pamidronate(125 mg) for 3 months. Blood chemistry and bone mineral density(BMD) were measured at baseline, and 3months. In addition, parathyroid hormone(PTH), serum osteocalcin, and urinary dipyridinoline levels were evaluated.
Results : In overall population, the mean lumbar spine BMD decreased from $0.754{pm}0.211(g/cm^2)$ to $0.728{pm}0.208(g/cm^2)$ in the placebo group(P<0.05) and increased from $0.652{pm}0.194(g/cm^2)$ to $0.658{pm}0.226(g/cm^2)$ in the pamidronate group(P>0.05).
Conclusion : Pamidronate appears to be effective in preventing SIO in children with glomerular diseases requiring long-term steroids therapy. Further careful observation and follow-up might be needed for children receiving bisphosphonates such as pamidronate.

Key words: Children | Steroid-induced osteoporosis(SIO) | Glomerular diseases | Pamidronate | Bisphosphonates