Densidade óssea na coluna em crianças com distrofia muscular de Duchenne tratadas com corticóides
Argentina – o trabalho demonstra mais uma vez que os pacientes com distrofia muscular de Duchenne apresentam redução da densidade óssea na coluna com o tratamento com corticóides, sendo que os valores eram mais baixos nos tratados com corticóides; é justificável o tratamento preventivo desta complicação em pacientes tratados com corticóides.
O resumo em inglês pode ser lido abaixo:
(Endocrine Review, 2012, 33) Spine Bone Mineral Density (BMD) in Children with Duchenne Muscular Dystrophy Treated with Corticosteroids
Gisella Viterbo, Cristina Tau, Soledad Monges, Juliana Catagneto, and Alicia Belgorosky – Argentina
Reduced mobility and glucocorticoids as adjunctive therapy may cause osteoporosis and fractures in children with Duchenne muscular dystrophy (DMD). We analyzed in 21 boys (mean age ± SD: 11.6 ±2.7y, weight SDS: -0.27±1.16 (-2.70 to 2.65), and height SDS: -1.77±0.87) DMD after treatment with deflazacort (n=13) or methylprednisone (n=8) during 3.8±2.4 years (range, 0.4-8.75), vitamin D (300 to 2400 IU/day) and calcium supplement (0.13 to 1 g/day) and calcium intake by dairy products of 607±231 mg/day: Lumbar L2-L4 BMD measured by dual-energy X-ray absorptiometry (Lunar, Prodigy), serum calcium (Ca), phosphate (P), alkaline phosphatase (AP), PTH, urinary calcium and D-Pyridoline/creatinine (uD-Pyr). Ten patients were wheelchair-bound (mean age: 13.2 ±2.3 y, immobilization time was 2.04 ±1.9 y) while long bone (n=3) and vertebral crush fractures (n=7) patients were also observed. The cumulative corticosteroid dose was 27.5±19.8 g (range: 4.7-65.7). Mean BMD z score was -2.2±1.5, ranging from -5.9 to 0.4. BMD z score was <-2 in 43%, and between -1 and -2 in 38%. Mean BMD z score was inversely correlated with age (p<0.001), time of immobilization (p<0.001), duration of corticosteroid therapy (p<0.01) and cumulative dose of corticosteroids (p<0.001). Significantly lower BMD z score (-3.78±1.26) was observed in patients with, in comparison with those without vertebral fractures (-1.43±0.62, p<0.005). The number of fractures was positively correlated with cumulative corticosteroids dose. Ca, P, AP and PTH were within the normal range. Urinary calcium and uD-Pyr were increased in 38 % and 56 % of the patients, respectively. In conclusion long-term immobilization and treatment with high corticoid doses affect bone mineralization in children with DMD and might worsen the outcome of the disease.
