Inhaled corticosteroids and bone health.

Area of Science:

• Pharmacology
• Endocrinology
• Bone Metabolism

Background:

• Inhaled corticosteroids (ICS) are primary treatments for asthma and COPD.
• Despite a generally low side effect profile, high-dose ICS can cause systemic adverse effects.
• These effects include detrimental impacts on bone health, leading to metabolic bone diseases.

Purpose of the Study:

• To review the mechanisms of inhaled corticosteroid-induced bone disease.
• To outline current management strategies for this condition.
• To highlight the relevance of established guidelines for glucocorticoid-induced osteoporosis.

Main Methods:

• Literature review focusing on ICS side effects and bone metabolism.
• Analysis of corticosteroid impact on osteoblast, osteocyte, and osteoclast function.
• Examination of established clinical guidelines for managing glucocorticoid-induced osteoporosis.

Main Results:

• High-dose ICS negatively affect osteoblast and osteocyte function and survival.
• ICS prolong osteoclast survival, contributing to metabolic bone disease.
• Glucocorticoid-induced osteoporosis (GIO) increases fracture risk (vertebral, hip).

Conclusions:

• ICS, particularly at high doses, pose a risk for systemic bone disease.
• American College of Rheumatology (ACR) guidelines for GIO management are applicable.
• Bisphosphonates, calcium, and vitamin D are recommended first-line treatments for ICS-induced bone disease.