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Cited by 169Bone health and osteoporosis researchGrowth Hormone and Insulin-like Growth FactorsBone Metabolism and Diseases

The impact of corticosteroids on growth and bone health

Open access
Mushtaq, T·2002·Archives of Disease in Childhood
DOI 10.1136/adc.87.2.93PMC PMC1719206
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Abstract

An examination of current evidence Glucocorticoids (GC) are important regulators of diverse physiological systems and are often used in the treatment of a number of chronic inflammatory, autoimmune, and neoplastic diseases. It is estimated that 10% of children may require some form of GC at some point in their childhood.1 Impairment of childhood growth with an approximate cortisone dose of 1.5 mg/kg/day was first described over 40 years ago; osteopenia in children receiving a prednisolone dose of less than 0.16 mg/kg/day has also been reported.2,3 The maintenance of growth and bone health is a complex process that can be influenced not only by drugs, but also by the nutritional status of the patient and the underlying disease process. The purpose of this review is to examine the current evidence for linking GC to adverse growth and bone health in childhood disorders that commonly require GC therapy. Loss of bone and deterioration in short term growth are dependent on the type and dose of GC and occur most prominently over the first six months of treatment.4–6 Although it is generally believed that GC affect trabecular bone more than cortical bone, a recent study of fractures in children following steroid exposure as part of acute lymphoblastic leukaemia (ALL) treatment showed a high incidence of cortical bone involvement, suggesting that the disease process may interact with GC usage in influencing site of bone loss.7,8 GC have a suppressive effect on osteoblastogenesis in the bone marrow and promote the apoptosis of osteoblasts and osteocytes, thus leading to decreased bone formation.9 Accumulation of apoptotic osteocytes may also explain the so called “osteonecrosis”, also known as aseptic or avascular necrosis. There is some evidence to suggest that GC may also increase bone resorption by extending the lifespan of …

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  • There is a potential for children to experience adverse effects associated with systemically administered steroids, such as osteoporosis and growth retardation, with suggestions that intranasal steroids may not lead to these abnormalities.

    “In terms of safety, there is a potential for children to experience adverse effects associated with systemically administered steroids, such as osteoporosis and growth retardation, with suggestions that intranasal steroids may not lead to these abnormalities (Mushtaq 2002).”

    From Topical and oral steroids for otitis media with effusion (OME) in children (2023) · cites this paper as Mushtaq 2002

    The introduction reports impaired growth and osteopenia in children receiving glucocorticoids, and the ASTHMA, ECZEMA, AND HAY FEVER section links oral therapy to delayed growth. That section suggests newer intranasal steroids may avoid adverse growth effects, but also reports reduced growth velocity with some intranasal steroids; it does not establish that intranasal steroids avoid osteoporosis. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • A study in Sweden of 588 CAH patients compared to a national population-based registry revealed excess mortality in CAH because of adrenal crises.

    “A study in Sweden of 588 CAH patients compared to a national population-based registry revealed excess mortality in CAH because of adrenal crises, 90 highlighting the importance of this aspect of the disease.”

    From Congenital adrenal hyperplasia (2017) · cites this paper as [90]

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Research works printed but not linked: 2

  1. Ahmed SF, Tucker P, Wallace AM, et al. The effects of prednisolone and dexamethasone on childhood growth and bone turnover during chemotherapy. Clin Endocrinol. In press.
  2. Halton JM, Atkinson SA, Fraher L, et al. Altered mineral metabolism and bone mass in children during treatment for acute lymphoblastic leukemia. J Bone Miner Res 1996;11:1774-83.

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Authors
Mushtaq, T.
Affiliations
Roslin Institute (GB)
Corresponding author
Mushtaq, T
ORCID
Mushtaq, T
Venue
Archives of Disease in Childhood
Publisher
BMJ
Published
2002-08-01
Volume
87
Issue
2
Pages
93-96
ISSN
  • 0003-9888 (ISSN-L)
  • 1468-2044
DOI
10.1136/adc.87.2.93
PMC
PMC1719206
OpenAlex
W2075729274
Cited by
169
References
72
Citations by year
2026: 3 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 12 · 2021: 11 · 2020: 15 · 2019: 12 · 2018: 9 · 2017: 10 · 2016: 8 · 2015: 6 · 2014: 5 · 2013: 6 · 2012: 5
FWCI
3.73
Type
journal article
Language
en
Open access
Locations
  • Archives of Disease in Childhood (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
Keywords
glucocorticoids, corticosteroid adverse effects, child growth, bone health, osteopenia, osteoporosis, avascular necrosis, osteoblast apoptosis, bone resorption, acute lymphoblastic leukemia
MeSH terms
Bone Development, Bone Diseases, Metabolic, Child, Glucocorticoids, Growth Disorders, Humans, Hypersensitivity, Immediate, Inflammatory Bowel Diseases

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