Supplemental Calcium Taken Daily Can Limit Early On-set of Osteoporosis in Children with Severe Asthma, National Jewish Research Finds

DENVER-Children with severe asthma should take an over-the-counter calcium supplement and a multi-vitamin every day to prevent bone loss associated with the disease, according to an article published in the October 2000 issue of the Journal of Allergy and Clinical Immunology.

"Osteoporosis is a common side effect of severe asthma," said Joseph Spahn, MD, an author of the article and a pediatric asthma specialist at National Jewish Medical and Research Center. "A child doesn’t have to be steroid dependent to get osteoporosis."

A retrospective study of 163 adolescents treated at National Jewish from 1993-1997 showed that the children suffered from bone loss because of inadequate dietary calcium, rather than the side effects of steroid use. In addition, girls were more likely to have osteoporosis than boys.

Bone densitometry scans were performed the all children during their treatment at National Jewish. Children also met with nutritionists, who found daily calcium intake to be low. Children whose records were examined took steroids daily, every other day or intermittently.

"If a child had inadequate calcium in his diet, he was more likely to have osteoporosis," Dr. Spahn said. "We found that only 5 to 10 percent of the children who came to National Jewish were taking a calcium supplement."

Simply taking 1,000 mg/day of calcium available in any drug store can help stop osteoporosis in children with severe asthma. Parents of children with asthma should check with their child’s physician before starting any new medical treatments.

Researchers did not find a connection between high usage of inhaled and oral steroids, and osteoporosis. Osteoporosis causes brittle bones and can lead to bone fractures, especially in active children. Nearly 5 million children in the United States have asthma.

Researchers also found that in the 1990s children had fewer growth problems than their counter-parts in the mid-1960s.

National Jewish looked at the side effects of steroids on adrenal gland suppression, cataracts, cushionoid disease and hypertension, making National Jewish’s study the most comprehensive ever published focusing on steroid side effects in children. The last time medical researchers performed a similar study was more than 35 years ago.

Because asthma is better controlled today—in the ’60s inhaled steroids didn’t exist as an asthma treatment—the disease has less of an impact on growth. Even though inhaled steroids can cause limited, short-term growth suppression—and children do catch up to the height of their peers as they get older—control of asthma is so much improved in the past three decades that the trade-off is a positive one for young patients. In addition, asthma itself can limit growth.

Inhaled corticosteroids decrease and prevent swelling of the airways. Oral corticosteroids, in pill or syrup form, relax tight muscles around airways.