Medicine of the Future in America

Decreased Bone Mineral Density in Premenopausal Asthma Patients Receiving Long-term Inhaled Steroids: Comment

Recently, it has been demonstrated that serum osteocalcin, a marker of osteoblast activity, is depressed in premenopausal adult women given 1 week of high-dose inhalational beclomethasone and not in those given a lower dose. The lack of consistent correlation of these risk factors with all four skeletal regions studied may be due to the small sample size.
The results of our study demonstrate that longterm use of inhalational steroids for the treatment of asthma is associated with decreased BMD at several sites comprised predominantly of trabecular bone, which is compatible with the known effect of corticosteroids on bone. Buy antibiotics add comment Relevant risk factors identified in this study include being female, receiving a higher average daily inhaled steroid dose, and a low BMI. The clinical significance of this decrease is not apparent from the present study, but there is good evidence that bone mass in the spine and proximal femur as measured by bone density, correlates with risks of vertebral and hip fractures, respectively.
It must be emphasized that this finding should not deter clinicians from prescription of inhaled steroids when indicated. The use of topical steroids in asthma has brought great advancement in the overall control of the disease and has allowed a dramatic decrease in the need for systemic steroids which have much more significant adverse side effects, including severe osteoporosis. It stands to reason that the benefits of the inhaled drug outweigh the potential side effects in the vast majority of patients. However, the recognition of this potential side effect of inhaled steroids is important. In terms of numbers of patients, many more are receiving regular long-term inhaled corticosteroids than maintenance low-dose oral steroids, and therefore, the population affected, if osteoporosis is a side effect, is not to be underestimated. Moreover, with the present trend of using higher and higher doses of inhaled steroids for asthma control, and possibly for the treatment of chronic bronchitis which usually affects the more elderly age group, the side effects may assume greater magnitude. Physicians should remember that asthma is a disease that often varies in severity throughout its course, or even within the year according to the seasons, and therefore the dose should be tailored to the patient’s current status to avoid unnecessary dosing. Meanwhile, more studies are needed to identify the risk factors so that we can appropriately screen and give prophylactic treatment to those patients who are likely to develop osteoporosis from inhaled steroid treatment.

This entry was posted in Asthma and tagged asthma, inhaled steroid, systemic steroids.
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