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Dose-related decrease in bone density among asthmatic patients treated with inhaled corticosteroids
N A Hanania1, K R Chapman, W C Sturtridge
1Asthma Centre, Toronto Hospital, University of Toronto, Canada.
The Journal of Allergy and Clinical Immunology
|November 1, 1995
Summary
Regular use of inhaled corticosteroids for asthma may suppress adrenal function and decrease bone density. Higher doses and longer duration of use correlate with these negative effects, impacting bone health.
Area of Science:
- Pulmonary Medicine
- Endocrinology
- Bone Metabolism
Background:
- Inhaled corticosteroids (ICS) are increasingly used for asthma management at higher doses.
- While considered to have lower systemic impact than oral steroids, ICS may still cause systemic side effects.
- This study investigated the impact of commonly prescribed ICS doses on bone density.
Purpose of the Study:
- To assess the effect of regular inhaled corticosteroid use on bone mineral density in asthma patients.
- To evaluate potential suppression of adrenal function due to inhaled corticosteroid therapy.
- To determine the relationship between ICS dose, duration, and bone density or adrenal function.
Main Methods:
- 36 asthma patients were divided into two groups: 18 on ICS (≥800 mcg/day for ≥1 year) and 18 on bronchodilators only.
- Adrenal function was assessed via morning serum cortisol and ACTH stimulation tests.
- Bone turnover markers (serum osteocalcin, alkaline phosphatase, urinary pyridinium cross-links) and bone mineral density (dual-energy x-ray absorptiometry) were measured.
Main Results:
- Patients on ICS showed significantly lower serum osteocalcin levels compared to the control group.
- ICS users exhibited significantly reduced Z scores for femoral neck bone density.
- A negative correlation was observed between ICS dose-duration (adjusted for BMI) and bone density/adrenal function.
Conclusions:
- Conventional doses of inhaled corticosteroids can suppress adrenal function in asthma patients.
- Regular ICS use is associated with decreased bone density in a dose-related manner.
- These findings highlight potential systemic risks of inhaled corticosteroid therapy on bone health.
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