Bone minderal density screening in a pediatric population with eosinophilic esophagitis
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Ellen Martin, Megan Patterson, MD, Sarah Beckwith, Mallikarjuna Rettiganti, PhD, Chunqiao Luo, MS, Peggy L. Chandler, APRN, Christina Tootle, APRN, Rebecca Levy, MD, Amy M. Scurlock, MD, Stacie M. Jones, MD, FAAAAI, Robbie D. Pesek, MD

Corticosteroids can compromise bone mineral density (BMD). While the risk of inhaled corticosteroid use is less compared to systemic steroids, higher doses can have deleterious effects on bone health. Currently, there are no published studies examining the effect of swallowed corticosteroids on BMD in patients with eosinophilic esophagitis (EoE). The study objectives were to determine the frequency and findings of BMD screening in a pediatric population with EoE.


Subjects, 2-18 years, with a diagnosis of EoE who were treated in the Arkansas Children’s Hospital EoE clinic during 2016-17 were evaluated. Data included demographics, diet and medication history, swallowed corticosteroids use/length of therapy, and BMD evaluation by dual energy x-ray absorptiometry (DEXA).


313 subjects were evaluated. 75% of subjects were male, 94% Caucasian. Thirty-six (11.5%) subjects had BMD screening performed. Fourteen of these subjects (38.9%) had abnormal results including osteopenia (10 of 14 subjects) and osteoporosis (5 of 14 subjects). There were no differences between subjects with normal versus abnormal BMD in regards to milk elimination or frequency of swallowed steroid treatment. Average length of swallowed steroid use was 1.6 years for all subjects. Budesonide was more commonly used than fluticasone propionate and 36% of subjects were also treated with ICS. Compared to fluticasone, budesonide was associated with a higher risk of abnormal BMD (p = 0.003).


There was a high rate of abnormal BMD findings, but a low rate of screening and possible selection bias. Prospective studies are needed to understand the effects of swallowed corticosteroids on BMD in EoE.