Reduced bone mineral density in childhood chronic idiopathic thrombocytopenic purpura treated with high-dose methylprednisolone

Dilber, Cengiz; Dağdemir, Ayhan; Albayrak, Davut; Albayrak, Selahattin; Kalaycı, Ayhan Gazi; Aliyazıcıoğlu, Yüksel; Başoğlu, Tarık

doi:10.1016/j.bone.2004.04.005

Cited by 11 publications

(9 citation statements)

References 28 publications

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“…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 , ).…”

Section: Impact Of Glucocorticoids In Patients With Itpmentioning

confidence: 99%

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

et al. 2019

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MethodologyThis Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at http://www. b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-gui deline/. The BSH produces Good Practice Papers to recommend good practice in areas where there is a limited evidence base but for which a degree of consensus or uniformity is likely to be beneficial to patient care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at

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Section: Impact Of Glucocorticoids In Patients With Itpmentioning

confidence: 99%

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

et al. 2019

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“…Treatment options are the same as in acute ITP [2,78,79,80,81,82,83,84], and in emergency treatment; intravenous methylprednisolone therapy and IVIG administration are effective [98]. Formulations other than oral prednisone, such as high-dose oral dexamethasone [86,87,88,89,90,91,92,93,94] or oral methylprednisolone [95,96,97,98], have been proposed to achieve long-term remission but cannot be recommended at the moment.…”

Section: Treatmentsmentioning

confidence: 99%

“…Nonetheless, all these treatments have significant side effects and do not increase the probability of recovery [69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98]. …”

Section: Treatmentsmentioning

confidence: 99%

“…There are specific recommendations about immunization of children before undergoing splenectomy [76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167<...>…”

Section: Treatmentsmentioning

confidence: 99%

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Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

et al. 2009

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Background/Objective: The management of chronic childhood idiopathic thrombocytopenic purpura (ITP) is distinct from acute ITP. Similar to the publication on acute ITP guidelines, the AIEOP (Associazione Italiana di Ematologia e Oncologia Pediatrica) considered it appropriate to develop consensus guidelines for chronic childhood ITP to provide useful and shared information for physicians, healthcare professionals, parents and patients. Design/Methods: A preliminary, evidence-based document issued by a select group of AIEOP pediatric hematologists was discussed, modified and approved during a Consensus Conference according to procedures previously validated by the AIEOP Board. Results: The guidelines give prominence to the periodical reevaluation of all the etiological hypotheses of thrombocytopenia in relation to its clinical condition. The majority of chronic ITP children do not require treatment, especially if bleeding is absent or minimal. The treatment decision depends on several factors other than the platelet count, and treatment options are suggested in relation to the therapeutic scenarios. Recommendations are given regarding support for surgery, particular hemorrhagic conditions, daily activities/sports, as well as for vaccines and drugs. Experimental treatments are also discussed.

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“…3 High-dose methylprednisolone (HDMP) therapy has been used for a long time in children with ITP; however, there are scanty of report about long-term adverse effects of this regimen on bone turnover. [4][5][6] In this study, we aimed to evaluate the late side effects of HDMP therapy on the skeletal system.…”

mentioning

confidence: 99%

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

Yıldırım

Büyükavcı²,

Eren³

et al. 2008

Journal of Pediatric Hematology/Oncology

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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.

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Reduced bone mineral density in childhood chronic idiopathic thrombocytopenic purpura treated with high-dose methylprednisolone

Cited by 11 publications

References 28 publications

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

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

Management of Chronic Childhood Immune Thrombocytopenic Purpura: AIEOP Consensus Guidelines

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

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