Tse, SzewahRolls, HillaryLitonjua, Augusto A.Van Natta, Mark L.Weiss, ScottTantisira, Kelan G.2016-05-162012Tse, Sze Man, H. William Kelly, Augusto A. Litonjua, Mark L. Van Natta, Scott T. Weiss, and Kelan G. Tantisira. 2012. Corticosteroid use and bone mineral accretion in children with asthma: Effect modification by vitamin D. Journal of Allergy and Clinical Immunology 130, no. 1: 53–60.e4. doi:10.1016/j.jaci.2012.04.005.0091-6749http://nrs.harvard.edu/urn-3:HUL.InstRepos:27003769Background— The adverse effects of corticosteroids on bone mineral accretion (BMA) have been well documented. Vitamin D insufficiency, a prevalent condition in the pediatric population, has also been associated with decreased bone mineral density (BMD). Objective— To determine whether children with asthma who have lower vitamin D levels are more susceptible to the negative effects of corticosteroids on BMD over time. Methods— Children aged 5–12 years with mild-to-moderate asthma who participated in the Childhood Asthma Management Program were followed for a mean of 4.3 years. Total doses of inhaled and oral corticosteroids (OCS) were recorded, serum 25-hydroxyvitamin D3 levels were measured at the beginning of the trial and serial DEXA scans of the lumbar spine were performed. Annual BMA rates were defined as: [(BMD at 4 years follow-up − BMD at baseline)/4 years]. Results— BMA was calculated for 780 subjects. In boys, baseline vitamin D levels significantly modified the relationship between OCS and BMA (vitamin D x OCS interaction, p=0.023). Stratification by vitamin D levels showed a decrease in BMA with increased use of OCS in vitamin D insufficient boys only (p<0.001). Compared to vitamin D sufficient boys, vitamin D insufficient boys exposed to more than 2 courses of oral corticosteroids per year had twice the decrease in BMA rate (relative to boys who were OCS-unexposed). Conclusions— Vitamin D levels significantly modified the effect of oral corticosteroids on bone mineral accretion in boys. Further research is needed to examine whether vitamin D supplementation in children with poorly controlled asthma may confer benefits to bone health.en-USasthmavitamin Dbone mineral densitycorticosteroidsJournal Article2016-05-1610.1016/j.jaci.2012.04.005