Incidence of Osteonecrosis in Asthmatic Children on Long-Term Steroids

Twenty-four asthmatic children ranging in age from 4 to 18 years (average 12.6 years) who had been treated with daily prednisone therapy of 10 to 60 mg/day for an average duration of 26.3 months were studied for possible early detection of bone and other steroid effects. Musculoskeletal symptoms were absent and orthopedic examinations as well as roentgenogram of the hips and shoulders were normal. Fourteen of 24 children had been on 10 mg/day for at least 1 year; and of these 14, 10 were cushingnoid and 7 children showed significant growth suppression, falling below the third percentile level when height measurements were plotted using the National Center for Health Statistics Growth Chart. For detection of early changes of osteonecrosis, bone scintigram using Technetium-99m pyrophosphate was utilized. Twenty-three patients had normal scans. One cushingoid boy with posterior subcapsular cataracts had asymmetry of uptake involving only the right humeral head on two occasions. These findings suggest that an asthmatic child on long-term prednisone therapy is more likely to develop a cushingoid body habitus or growth suppression associated with cataract formation before the child develops osteonecrosis. Children on less than 10 mg/day had no significant steroid side effects.