Long‐term effects of high‐dose systemic corticosteroids on growth and bone mineral density in patients treated for childhood interstitial lung disease (chILD)

Abstract

AbstractBackgroundChildren's interstitial lung disease (chILD) is a rare and potentially life‐threatening condition. For many chILD conditions, systemic corticosteroids (sCCS) are considered the primary treatment despite a broad spectrum of potential side effects.AimWe aimed to determine the long‐term effects of sCCS treatment on growth, bone mineral density (BMD), and body composition after chILD.Materials and MethodsThis descriptive cross‐sectional single‐center study included patients diagnosed with chILD before the age of 18 years treated with sCCS in the period 1998–2020. Dual‐energy X‐ray absorptiometry, anthropometric measurements, bone age determination, and blood tests were performed in 53 (55% males) of 89 eligible patients.ResultsMedian (range) age was 19.3 (6.4;30.7 years). Participants received a median (range) cumulative sCCS dose of 1144 (135; 6178) mg over a 2.0 (0.1; 13.8) years period and latest dose was administered 11.7 (1.2; 19.6) years before follow‐up. Mean delta height (height standard deviation scores [SDS] – target height SDS) was reduced at sCCS treatment initiation (mean: −0.55, 95% confidence interval [CI]: −0.91; −0.20, p < .005) and at sCCS treatment cessation (mean: −0.86, 95% CI:−1.22; −0.51, p < .001), but normalized in the majority at follow‐up (mean: −0.29, 95% CI:−0.61; 0.03, p = .07). Mean (SD) BMD z‐score for the spine and whole body was −0.34 (1.06) and 0.52 (1.13), with no significant correlation to sCCS dose. Excess body fat (>30% in females, >25% in males) was found in 58% of patients.ConclusionLong‐term treatment with sCCS did not cause significant long‐term reduction of height but showed subtle effects on fat mass percentage and BMD. Given the severity of chILD, the observed long‐term effects of sCCS on growth and BMD appear acceptable.