Doença Óssea Induzida Pelos Glicocorticoides: Mecanismos E Importância Na Prática Pediátrica

Abstract

Objective: To describe mechanisms by which glucocorticoids cause osteoporosis, with fracture risk, combining this learning with a possible professional behavior change.Data sources: A systematic search on SciELO, PubMed, Scopus, and Medline databases was carried out for consensus, review articles, including systematic reviews and meta-analysis, which were published in English, between 2000 and 2016. Keywords used on the search were the following: glucocorticoids, fractures, osteoporosis, bone health, vitamin D, children, and adolescents.Data synthesis: The review was divided into four topics: 1) introduction, with a brief focus on pediatric fractures; 2) osteoporosis in children and adolescents, highlighting it as a silent cause of fractures; 3) glucocorticoids and secondary bone disease, describing deleterious mechanisms of this steroids group on bone structure; 4) molecular effects of glucocorticoids excess on bone, with details about the harmful mechanisms on bone molecular level.Conclusions: Glucocorticoids excess determines early bone disease, favoring the occurrence of fractures. Thus, a child or an adolescent who uses glucocorticoids, especially systemically and chronically, but also repeats cycles at high cumulative doses of the medication, needs care and guidance related to bone health at the onset of treatment. On the other hand, the presence of fractures, even if related to trauma, can be a sign of underlying and unknown bone fragility, which may be secondary to the use of glucocorticoids and/or vitamin D deficiency.

Prevalence and Predictors of Compromised Bone Mineral Density in Pediatric Eosinophilic Esophagitis

“…Our results are complementary to a recent study showing a negligible effect on linear growth from swallowed topical steroid use in pediatric patients with EoE (15). Interestingly, we also did not find an association with systemic steroid use, which is known to negatively affect bone health (4,16). This lack of effect was likely due to the short (5 days or less) systemic steroid courses the patients in this cohort were prescribed, rather than prolonged use as is commonly seen in patients with chronic inflammatory diseases.…”

“…Glucocorticoid-induced bone disease is a well-known side effect of systemic steroids (4). The long-term effects of swallowed topical steroids and the combined effects of exposure to steroids via multiple routes are unknown.…”