Decreased bone mineral density in premenopausal asthma patients receiving long-term inhaled steroids.

Inhaled corticosteroids have become a key element in the maintenance treatment of bronchial asthma. It is well-known that long-term systemic steroid use causes osteoporosis, whereas its inhaled counterpart has been believed to be devoid of such a side-effect. However, recent studies showed that administration of inhaled corticosteroids was associated with biochemical evidence of derangement in bone turnover. We therefore studied bone mineral density (BMD) by dual energy x-ray absorptiometry in 30 patients (18 females, 12 males) with bronchial asthma treated with steroids, essentially by the inhaled route only (both nasal and tracheobronchial), and compared them with healthy subjects individually matched for age, sex, menopausal status, and body mass index (BMI). There was a significant decrease in BMD in the patient group at the hip (neck of femur, p = 0.007; trochanter of femur, p = 0.034; Ward's triangle, p = 0.016) and the lumbar area of the spine (L2-4, p = 0.041). Further analysis showed that this difference from control subjects was mainly seen in the female patients and not in the male patients (neck of femur, p = 0.049; Ward's triangle, p = 0.025; lumbar spine, p = 0.039). In the female patients, there was significant negative correlation of BMD of the lumbar area of the spine and the trochanter of femur with daily inhaled steroid dose and positive correlation of BMD of the trochanter with BMI.

[1]  J. Leech,et al.  Effects of short-term inhaled budesonide and beclomethasone dipropionate on serum osteocalcin in premenopausal women. , 1993, The American review of respiratory disease.

[2]  R. Swaminathan,et al.  A longitudinal study of the determinants of bone mass in Chinese women aged 21 to 40. I. Baseline association of anthropometric measurements with bone mineral density. , 1993, Annals of epidemiology.

[3]  R. Pauwels.  The international consensus report on the diagnosis and management of asthma , 1993 .

[4]  J. Douglas,et al.  Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids. , 1992, Thorax.

[5]  T. Higenbottam,et al.  High dose nebulized steroid in the treatment of chronic steroid-dependent asthma. , 1992, Respiratory medicine.

[6]  A B Thompson,et al.  Aerosolized beclomethasone in chronic bronchitis. Improved pulmonary function and diminished airway inflammation. , 1992, The American review of respiratory disease.

[7]  J. Baskerville,et al.  Effects of dose and dosing schedule of inhaled budesonide on bone turnover. , 1991, The Journal of allergy and clinical immunology.

[8]  J. Aloia,et al.  Effect of inhaled corticosteroid on bone density in asthmatic patients: a pilot study. , 1991, Annals of allergy.

[9]  M. Prummel,et al.  Beclomethasone inhalation decreases serum osteocalcin concentrations. , 1991, BMJ.

[10]  S. Capewell,et al.  Bone turnover during high dose inhaled corticosteroid treatment. , 1991, Thorax.

[11]  D M Eddy,et al.  Screening for osteoporosis. , 1990, Annals of internal medicine.

[12]  L. Raisz,et al.  Glucocorticoid-induced osteoporosis: pathogenesis and management. , 1990, Annals of internal medicine.

[13]  K. Pun,et al.  Calcium and other dietary constituents in Hong Kong Chinese in relation to age and osteoporosis. , 1990 .

[14]  I. Reid.  PATHOGENESIS AND TREATMENT OF STEROID OSTEOPOROSIS , 1989, Clinical endocrinology.

[15]  P. Tothill,et al.  Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica. , 1986, British medical journal.

[16]  A. Adinoff,et al.  Steroid-induced fractures and bone loss in patients with asthma. , 1983, The New England journal of medicine.

[17]  S. Johansson,et al.  Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. , 1982, European journal of respiratory diseases. Supplement.