Ups Risk of Osteoporosis
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
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
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.
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
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.
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.
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.
The New England Journal of Medicine 2001;345:941-947, 989-991.
Reference Source 89
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