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Inhaled corticosteroids increase risk of osteoporosis
Title:Inhaled corticosteroid use and bone-mineral density in patients with asthma
Author: C. Wong, et al.
Address: Nottingham, UK
Source: The Lancet 355:1399-1403 (April) 2000
Summary: Researchers studied the dose-response relation between cumulative inhaled corticosteroid dose and bone-mineral density at the lumbar spine and proximal femur in 196 adults (119 women) with asthma. Patients had taken an inhaled corticosteroid regularly for at least 6 months, and had had limited exposure to systemic steroids. Median duration of inhaled corticosteroid treatment was 6 years and median cumulative dose was 876mg. There was a negative association between cumulative dose of inhaled corticosteroid and bone-mineral density at the lumbar spine, femoral neck, Ward's triangle, and trochanter, both before and after adjustment for the effects of age and sex. A doubling in dose of inhaled corticosteroid was associated with a decrease in bone-mineral density at the lumbar spine. Similar decreases were found at the femoral neck, WardÕs triangle, and trochanter. Researchers concluded that there is a negative relation between total cumulative dose of inhaled corticosteroid and bone-mineral density in patients with asthma. The benefits have to be weighed against the risks, and inhaled corticosteroids are clearly highly effective in the control of asthma and reducing the need for oral corticosteroids.
Comment: Long-term use of higher doses may be a predisposition for osteoporosis. The lowest dose of steroids should be used that adequately controls asthma. Densitometry and early intervention is warranted.