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Effects of inhaled corticosteroids on bone
G P Bootsma1, P N Dekhuijzen, J Festen
1Department of Pulmonary Diseases, University Hospital Nijmegen, Netherlands.
The Netherlands Journal of Medicine
|June 1, 1997
Summary
Inhaled corticosteroids (ICS) are effective for asthma but may affect bone health. Higher doses can decrease bone markers, though long-term clinical relevance and fracture risk remain uncertain.
Area of Science:
- Pulmonology
- Endocrinology
- Bone Metabolism
Background:
- Inhaled corticosteroids (ICS) are a cornerstone therapy for asthma management.
- The widespread use of ICS necessitates an understanding of potential systemic adverse effects.
- Oral corticosteroids (OCS) are known to cause osteoporosis, prompting investigation into ICS effects on bone.
Purpose of the Study:
- To review the current evidence on the impact of inhaled corticosteroids on bone health.
- To assess the relationship between ICS dosage and bone metabolism markers.
- To evaluate the potential for bone density changes and fracture risk associated with ICS use.
Main Methods:
- Literature review focusing on studies examining ICS effects on bone.
- Analysis of data on serum osteocalcin levels in relation to ICS dosage.
- Examination of studies reporting bone density changes and confounding factors.
Main Results:
- Doses of ICS exceeding 1.0 mg/day are associated with a dose-dependent decrease in serum osteocalcin.
- Some studies suggest decreases in bone density with ICS treatment, but confounding factors like prior OCS use limit definitive conclusions.
- No significant differences were found between beclomethasone dipropionate, budesonide, and fluticasone propionate per milligram.
Conclusions:
- While ICS can impact bone metabolism markers, the long-term clinical significance and fracture risk remain largely unknown.
- The lowest effective ICS dosage should be used to minimize potential systemic effects.
- Further research is needed to clarify the long-term bone health implications of ICS therapy.