Q. What is the best preventive treatment approach to protect the bones of children with lupus who have to take corticosteroids?
A. Bone health in children with lupus is very important. While physicians treating children with lupus have a high level of awareness about how the toxicities of the medication used to treat the disease affect the skeleton and how the disease itself affects bone health, we have not done enough studies to know how best to treat this problem. At this time, I am comfortable recommending adequate calcium and vitamin D supplementation. In addition, an effort should be made, despite the disease, to have children do some kind of exercise four to five times a week for 30 minutes. Even with lupus, the combination of calcium, vitamin D, and exercise will work to lay down new and healthy bone. In addition, for children on high doses of glucocorticoids and/or immunosuppressive medications, cautious use of mild anti-resorptive agents like calcitonin could bee considered. On the bright side, when lupus activity lessens, children often have catch-up bone growth.
For adults with lupus on glucocorticoids, there are a number of bone-active medications that we can use to prevent and treat bone loss. However, studies that carefully evaluate the benefits and risks associated with a growing skeleton in children with lupus have not been done. Therefore, I am taking a conservative approach and waiting until such studies are done before prescribing bone-active medications to children.