Common Asthma Therapy
Ups Risk of Osteoporosis

NEW YORK (Reuters Health) - Young women who use inhaled steroids to control their asthma may be putting themselves at risk of developing osteoporosis and hip fracture over the long term, new study findings suggest.

The study revealed that inhaled glucocorticoids, or steroids, which are among the safest and most effective treatments for persistent asthma, were associated with a loss of bone density in the hip and upper thighbone, and that higher doses correlated with greater bone loss in premenopausal women. Bone density in other areas such as the femoral neck (part of the thighbone between the knob-like head of the femur and the upper thighbone) and the spine was not affected.

The results indicate that healthcare providers should prescribe the lowest possible doses of inhaled steroids for premenopausal women with asthma and take steps to minimize bone loss among patients who receive higher doses, the researchers report in the September 27th issue of The New England Journal of Medicine.

``Overall, these findings do not suggest that patients should stop their steroid inhalers, or tolerate poor asthma control, but rather they should work with their doctors to find the lowest dose of inhaled glucocorticoid that can be used to achieve control of their asthma symptoms,'' Dr. Elliot Israel, the study's lead investigator from Harvard Medical School in Boston, Massachusetts, said in a statement.

Inhaled steroids reduce inflammation in the airways. While steroids taken orally are known to reduce bone mass, it is unclear whether steroids taken through an inhaler have the same effect.

To investigate, the researchers measured bone density at various sites in 109 women aged 18 to 45, over a 3-year period. All women were treated with a particular steroid, triamcinolone acetonide, with an inhaler that delivered 100 micrograms of medication per puff.

Women who inhaled more than eight puffs a day experienced more bone loss than women consuming four to eight puffs daily, and both groups lost more bone from key areas compared with a group of women who did not take inhaled glucocorticoids. In fact, each additional puff was associated with a decline in bone density in certain areas of the skeleton.

In an accompanying editorial, Dr. Bess Dawson-Hughes from Boston-based Tufts University adds that healthcare providers should monitor bone density in young women taking these medications and recommend weight-bearing exercise and adequate intake of calcium and vitamin D, which help to preserve bone.

SOURCE: The New England Journal of Medicine 2001;345:941-947, 989-991.

Reference Source 89

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