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

Abstract

There are no robust guidelines on strategies to prevent the adverse skeletal effects of glucocorticoids in children. 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 (12weeks), high-dose glucocorticoids. Prospective, randomized, controlled, single blind, interventional study conducted on 41 steroid-naïve pre-pubertal children (29 boys, 12 girls). All children received prednisolone for 12weeks (60mg/m(2)/day daily for 6weeks, followed by 40mg/m(2)/day alternate days for 6weeks). Recruited children were randomized into the intervention group (IG; vitamin D 1,000IU/day and elemental calcium 500mg/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 12weeks. Mean percentage changes in BMC and BMD in IG and CG were compared. 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). 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.