ESPE Abstracts

Background: Corticosteroids are medicines that are used to treat many chronic diseases. They are very effective anti-inflammatory drugs by suppressing the immune system, and are also used as a replacement therapy in conditions with low levels of endogenous cortisol. Glucocorticoid effects on bone metabolism include: reduced absorption of calcium in the intestine; increased calcium urinary excretion; increased bone resorption and reduced bone density. Corticosteroid treatment increase the activity of the 24-hydroxylase (CYP24A1), and thereby reduce the level of 25-Hydroxy Vitamin D (25-OH-D). Patients on a long term treatment with oral glucocorticoids have significantly lower levels of 25-OH-D, decreased mineral bone density and osteoporosis. Measuring the level of serum 25-OH-D is very important to determine vitamin D status in this group of patients.

Case: We present five children with chronic diseases on a long term treatment with corticosteroids. Three of them are with progressive muscular dystrophy and two children are with chronic arthritis. The first studies in all patients showed low level of 25-OH-D–35 to 45 nmol/l, normal range is 80–200 nmol/l. This required the application of vitamin D3. The tests after treatment showed normal level of 25-OH-D, parathyroid hormone, alkaline phosphatase and calcium in the serum, and normal calcium/creatinine ratio in the urine.

Conclusion: Vitamin D is very important for calcium homeostasis and for optimal bone metabolism and health. Children treated for a long period with oral corticosteroids often have low levels of 25-OH-D. In these patients it is necessary to check 25-OH-D levels regularly and treat the impaired vitamine D status with oral vitamin D supplementation.