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Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective, randomized, controlled, interventional study

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Abstract

Background

There are no robust guidelines on strategies to prevent the adverse skeletal effects of glucocorticoids in children.

Objectives

To evaluate the role of prophylactic calcium and vitamin D on bone health in children with new-onset nephrotic syndrome (NS) treated with short-term (12 weeks), high-dose glucocorticoids.

Methods

Prospective, randomized, controlled, single blind, interventional study conducted on 41 steroid-naïve pre-pubertal children (29 boys, 12 girls). All children received prednisolone for 12 weeks (60 mg/m2/day daily for 6 weeks, followed by 40 mg/m2/day alternate days for 6 weeks). Recruited children were randomized into the intervention group (IG; vitamin D 1,000 IU/day and elemental calcium 500 mg/day) and the control group (CG). Bone mineral content (BMC) and bone mineral density (BMD) at the lumbar spine (L1–L4) were estimated at baseline and at 12 weeks. Mean percentage changes in BMC and BMD in IG and CG were compared.

Results

Children in the IG showed an increase of 11.2 % in BMC versus the CG, who showed an 8.9 % fall (p < 0.0001). Net intervention-attributable difference in BMC was 20.1 %. BMD increased in both groups (IG 2.8 % vs CG 0.74 %), but the difference was not statistically significant (p = 0.27).

Conclusions

Short-term, high-dose glucocorticoid therapy decreases the BMC of the lumbar spine in steroid-naïve children with NS. Vitamin D and calcium co-administration not only prevents this decline, but also enhances BMC of the lumbar spine.

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Acknowledgements

The authors are grateful to all study participants and their families, to Nithya Joseph, Prasanna Samuel, and Dr B Antonisamy for their assistance with statistical analyses, and to Dr Narayanan Kandasamy and Prof A N Choudhary for their helpful comments on the manuscript.

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Authors and Affiliations

  1. Department of Child Health, Christian Medical College (CMC), Vellore, 632004, Tamil Nadu, India

    Surabhi Choudhary

  2. Paediatric Nephrology Division, Department of Child Health, Christian Medical College (CMC), Vellore, 632004, Tamil Nadu, India

    Indira Agarwal

  3. Department of Endocrinology and Metabolism, Christian Medical College (CMC), Vellore, 632004, Tamil Nadu, India

    Mandalam S. Seshadri

  4. 7/12, University Colony, Bariatu, Ranchi, 834009, Jharkhand, India

    Surabhi Choudhary

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  1. Surabhi Choudhary
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Correspondence to Surabhi Choudhary.

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Choudhary, S., Agarwal, I. & Seshadri, M.S. Calcium and vitamin D for osteoprotection in children with new-onset nephrotic syndrome treated with steroids: a prospective, randomized, controlled, interventional study. Pediatr Nephrol 29, 1025–1032 (2014). https://doi.org/10.1007/s00467-013-2720-4

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  • DOI: https://doi.org/10.1007/s00467-013-2720-4

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