Hansen Karen E, Kleker Brian, Safdar Nasia, Bartels Christie M
Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Dermatology, Kaiser Permanente, La Mesa, CA.
Semin Arthritis Rheum. 2014 Aug;44(1):47-54. doi: 10.1016/j.semarthrit.2014.02.002. Epub 2014 Feb 11.
To summarize the published effects of systemic glucocorticoid therapy on bone mineral density (BMD) and fractures in children.
We performed a systematic review and meta-analysis of existing literature, using Medline, CINAHL, and Cochrane databases to identify studies of BMD or fractures in children ≤18 years taking systemic glucocorticoid therapy. We excluded studies of inhaled glucocorticoids, chemotherapy, and organ transplantation. Two authors reviewed abstracts for inclusion, read full-text articles to extract data, and rated each study using the Downs-Black scale.
A total of 16 studies met eligibility criteria, including 10 BMD (287 children) and six fracture (37,819 children) studies. Spine BMD was significantly lower (-0.18; 95% CI = -0.25; -0.10 g/cm(2)) in children taking glucocorticoid therapy, compared to age- and gender-matched healthy controls. Spine BMD was also lower (-0.14; 95% CI = -0.27; 0.00 g/cm(2)) in children taking glucocorticoids, compared to children with the same disease not taking glucocorticoids. Incident clinical fracture rates varied from 2% to 33%. Morphometric vertebral fracture incidence ranged from 6% to 10%, and prevalence was 29-45%.
Published data suggest that children treated with glucocorticoid therapy have lower spine BMD compared to healthy children. Whether children receiving glucocorticoid therapy have lower spine BMD compared to children with milder disease not requiring such therapy is not certain. Clinical and morphometric vertebral fractures are common, although only one study assessed fracture rates in healthy controls. Additional well-designed, prospective studies are needed to evaluate the skeletal effects of glucocorticoid therapy in children.
总结已发表的全身糖皮质激素治疗对儿童骨密度（BMD）和骨折的影响。
我们对现有文献进行了系统评价和荟萃分析，使用Medline、CINAHL和Cochrane数据库来识别接受全身糖皮质激素治疗的18岁及以下儿童的BMD或骨折研究。我们排除了吸入性糖皮质激素、化疗和器官移植的研究。两位作者审查摘要以确定是否纳入，阅读全文文章以提取数据，并使用唐斯-布莱克量表对每项研究进行评分。
共有16项研究符合纳入标准，包括10项BMD研究（287名儿童）和6项骨折研究（37819名儿童）。与年龄和性别匹配的健康对照相比，接受糖皮质激素治疗的儿童脊柱BMD显著降低（-0.18；95%CI=-0.25；-0.10g/cm²）。与未接受糖皮质激素治疗的同病儿童相比，接受糖皮质激素治疗的儿童脊柱BMD也较低（-0.14；95%CI=-0.27；0.00g/cm²）。临床骨折发生率从2%到33%不等。形态计量学椎体骨折发生率从6%到10%不等，患病率为29%-45%。
已发表的数据表明，与健康儿童相比，接受糖皮质激素治疗的儿童脊柱BMD较低。与病情较轻不需要此类治疗的儿童相比，接受糖皮质激素治疗的儿童脊柱BMD是否较低尚不确定。临床和形态计量学椎体骨折很常见，尽管只有一项研究评估了健康对照中的骨折发生率。需要更多设计良好的前瞻性研究来评估糖皮质激素治疗对儿童骨骼的影响。
