Inhaled corticosteroids may have a beneficial effect on bone metabolism in newly diagnosed asthmatic children

Background: The adverse effect of inhaled corticosteroids (ICS) treatment on bone metabolism in children with asthma is still controversial, and a possible beneficial effect of vitamin D added to ICS on bone turnover is uncertain. Objective: We conducted a randomized, double-blind, parallel-group, 6-month trial to assess the effects of a medium and high dose of ICS and a high-dose ICS with vitamin D on bone metabolism in children with newly diagnosed atopic asthma. Methods: 96 children were equally randomized to 4 groups receiving the following doses of inhaled budesonide [mu g/day]: 400 (ICS 400 group), 800 (ICS 800 group), 800 with oral vitamin D (ICS 800 with vit D group), and montelukast as a control (control group). Markers of bone production (osteocalcin, alkaline phosphatase) and bone degradation (amino-terminal cross-linked telopeptide of type I collagen - NTx, carboxy-terminal telopeptides of type I collage), and also concentration of 25-hydroxycholecalciferol (25OH D) and calcium phosphorus balance (calcium, phosphorus, parathormon-PTH) in serum and/or urine were assessed twice: before and after 6 months of treatment. Results: We obtained a significant decrease in phosphorus and PTH serum levels in ICS 400 and ICS 800 with vit D groups compared to control group, and a significant decrease of NTx urine level in ICS 800 with vit D group. Conclusions: Medium doses of inhaled corticosteroids exert an advantageous effect on bone metabolism in newly diagnosed asthmatic children. Vitamin D together with a high dose of inhaled corticosteroids has a beneficial effect on both calcium-phosphorus balance and collagen turnover. (C) 2011 Elsevier Ltd. All rights reserved.