Is there a way to prevent steroid-induced bone loss in children and young people?

Despite the successful introduction of biological therapies for children and young people with rheumatic diseases, a significant proportion continue to be treated with steroids as, for many, this remains the only means of treating and controlling their condition. However, steroids are known to contribute to the bone loss, bone pain and increased risk of fracture seen in this population.

In order to help prevent steroid-induced bone loss, evidence-based strategies are in place, although at present these only exist for adults. Currently, paediatric rheumatologists do tend to prescribe calcium and vitamin D supplements to children and young people, or bisphosphonates for those at higher risk, in order to help minimise the negative effects of steroid treatment. However, lack of evidence means there is little consensus between healthcare professionals as to which treatments are best for skeletal protection in children.

In order to overcome this, a Versus Arthritis funded study at Queen’s University Belfast has successfully undertaken the first randomised controlled trial large enough to answer the question of whether an active form of vitamin D (alfacalcidol) or a drug known to prevent bone loss in adults (bisphosphonate risedronate) can help to prevent or reduce bone loss in children receiving steroids for chronic rheumatic diseases.

A total of 217 children and young people aged between 4 and 18 years were successfully recruited to the trial and split into three groups: placebo, alfacalcidol treatment or risedronate treatment. The researchers found that those receiving risedronate treatment had significantly increased bone mineral density compared to placebo or alfacalcidol treatment after one year, providing the first substantial evidence for the effective use of bisphosphonates to prevent steroid-induced bone loss in children.

As a result of their findings, the researchers advise consideration by healthcare professionals for the use of bisphosphonate risedronate in children and young people who are receiving steroids for inflammatory conditions, especially for those who are at high risk of fracture.

More information can be found in the published article.