FACTORS AFFECTING BONE MINERAL DENSITY IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME

Abstract

Background: Children with idiopathic nephrotic syndrome (INS) are at increased risk of developing bone mineral density (BMD) abnormalities due to the long-term use of corticosteroids, vitamin D deficiency, and physical inactivity. Objective: This study aimed to investigate the factors affecting BMD in children with INS, with a focus on corticosteroid therapy, nutritional status (calcium and vitamin D levels), physical activity, and laboratory markers.

 Methods: A cross-sectional observational study was conducted at the Department of Nephrology, The Children's Hospital Lahore from November 2024 to April 2025. A total of 70 children diagnosed with INS were included in the study. BMD was measured using dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femoral neck. The children’s cumulative corticosteroid dose, calcium and vitamin D levels, physical activity levels, and serum albumin were recorded.

Results: The mean age of the participants was 8.6 ± 3.2 years, with a slight female predominance (51.4%). BMD classification revealed 40% of children had normal BMD, 45.7% had osteopenia, and 14.3% had osteoporosis. Corticosteroid use was negatively correlated with BMD (r = -0.62, p < 0.01). Serum calcium and vitamin D levels were significantly lower in children with osteopenia and osteoporosis (p < 0.05). Physical activity showed a positive correlation with BMD (p < 0.05), with children in the high activity group having higher BMD than those in the low activity group.

Conclusion: Corticosteroid therapy, vitamin D deficiency, and low physical activity are key factors influencing bone mineral density in children with INS. Optimizing corticosteroid use, ensuring adequate calcium and vitamin D intake, and promoting physical activity are essential strategies for preventing bone demineralization in this population. Early screening and intervention are recommended to reduce the risk of long-term skeletal complications in children with INS.