Late Side Effects of High-dose Steroid Therapy on Skeletal System in Children With Idiopathic Thrombocytopenic Purpura

Abstract

Corticosteroids have been widely used in the treatment of idiopathic thrombocytopenic purpura (ITP). We evaluated the late side effects of high-dose methylprednisolone (HDMP) therapy on bone metabolism in children with ITP. Twenty-eight children with acute ITP treated with HDMP (30 mg/kg/d for 3 d then 20 mg/kg/d for 4 d) and 28 controls were enrolled in the study. Bone mineral density (BMD), urinary calcium creatinine ratio, urinary levels of deoxypyridinoline, serum levels of calcium, phosphate, parathyroid hormone, total alkaline phosphatase, and bone-specific alkaline phosphatase were measured in both groups. Magnetic resonance imaging of the femoral head was performed only in study group. The mean levels of serum phosphate, parathyroid hormone, urinary deoxypyridinoline, and calcium creatinine ratio were significantly increased in the study group. There was no significant difference between the 2 groups in terms of serum calcium, total alkaline phosphatase, bone-specific alkaline phosphatase, and BMD values. There was a statistically significant negative correlation between cumulative steroid dose and BMD values in study group (r = -0.379). Osteonecrosis was observed in 3 of 25 patients by magnetic resonance imaging. In conclusion, HDMP therapy, especially in high cumulative doses, increases the bone resorption and may cause osteonecrosis in children with ITP.

The prevention of glucocorticoid‐induced osteoporosis in patients with immune thrombocytopenia receiving steroids: a British Society for Haematology Good Practice Paper

“…Our systematic review identified four case series or case‐control studies of between 24 and 36 children and one adult series of 18 patients assessing BMD after steroids (Table SI). In children, there was a significant negative correlation between BMD and cumulative steroid dose (Dilber et al , ; Yildirim et al , ; Tantawy et al , ). In one series, 9/36 (25%) children had osteopenia (BMD Z‐score ≤1) and one had osteoporosis (BMD Z‐score ≤−2 plus a clinically significant fracture) (Tantawy et al , ).…”

Isolated Knee Osteonecrosis Secondary to Corticosteroid Use in Two Patients with Idiopathic Thrombocytopenic Purpura

“…Steroidler birçok farkl› klinik durumda tedavi amac›yla kullan›l-maktad›r. Steroidlerin iskelet sistemine direkt ve indirekt etkileri bilinmektedir (2). Kortikosteroidler osteoblastlar›n replikasyonu, diferansiasyonu ve fonksiyonlar›n› bozar ve olgun osteoblast ve osteositlerin apopitoza gitmelerine neden olarak kemik kayb›n› art›r›rlar.…”

“…Kortikosteroidler osteoblastlar›n replikasyonu, diferansiasyonu ve fonksiyonlar›n› bozar ve olgun osteoblast ve osteositlerin apopitoza gitmelerine neden olarak kemik kayb›n› art›r›rlar. Kortikosteroidlere ba¤l› osteonekroz mekanizmas› tam olarak anlafl›lmam›fl olsa da farkl› çal›flmalarda bu kemik kayb›n›n nekroza neden olabilece¤i belirtilmifltir (2,3). Bununla birlikte steroid kullan›m›na ba¤l› olarak adiposit say›s›nda ve büyüklü-¤ünde art›fl kemik ili¤inde yer de¤ifltirmeye neden olmaktad›r.…”

Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature

“…In many cases, the exact mechanism of ON is unknown; however, in nontraumatic ON, the pathogenesis is believed to involve vascular compromise, bone and cell death, or defective bone repair (1). Corticosteroid use has often been indicated as a cause of ON (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16); however, again this has most commonly affected the femoral head. Bisphosphonates have also been implicated as a cause of ON, with most published data pointing to its manifestation in the jaw (7,17).…”