The Effects of Glucocorticoids on Bone Strength in Children with Renal Diseases

We evaluated the effect of glucocorticoids (GCs) on bone strength via bone mineral density (BMD) scores and serum alkaline phosphatase (S-ALP) levels in children with idiopathic steroid-sensitive nephrotic syndrome (ISSNS) or IgA nephropathy (IgAN). Sixteen children with ISSNS and 13 with IgAN were eligible for this study. The BMD and S-ALP levels were measured before the initiation of steroid treatment (STx), one month after initiation of STx and one month after terminating STx (Phases 0, 1 and 2). For IgAN, scores and levels were measured before the initiation of STx (Phase 0) and 1, 3, 6, and 12 months after the initiation of STx (Phases 1, 2, 3, and 4). In ISSNS, the BMD and S-ALP levels were significantly lower in Phase 1 than in Phase 0; however, scores and levels returned to baseline in Phase 2. In IgAN, BMD was significantly lower in Phase 2 than in Phase 0 while S-ALP levels were significantly lower in Phases 1, 2, and 3 compared to Phase 0. No significant difference was observed between Phase 0 and Phase 4. In ISSNS, bone strength recovered one month after terminating STx. In IgAN, bone strength recovered 10 months after tapering of STx.