We have excluded all those in whom the history of steroid intake was uncertain, such as irregular use of inhaled steroids, possible use of systemic steroids in the distant past, or prescription for their use by practitioners outside our clinics. Thus, patients in this study received steroids predominantly by the topical route, with an average of about three short courses of systemic steroids during their chronic disease. The z scores of BMD of the two groups with and without intermittent systemic steroid use were not significantly different, suggesting that the decrease in BMD was not related to the systemic steroid. buy antibiotics
Both BDP and BUD have been used in our patients, and there have been studies that suggest that they are not of equal potency in terms of systemic side effects. We have not particularly differentiated between the two groups because a few patients have gone from one preparation to another in the long course of treatment. We have included nasal steroids in the evaluation, since many patients with asthma also have rhinitis, and the cumulative dose via the nasal route was not negligible.
Bone mass is affected by multiple factors in healthy individuals and by certain disease states per se. Overall analysis showed that the incidence of systemic glucocorticoid-induced osteoporosis is less than 50 percent, and it is accepted that other risk factors contribute to osteopenia apart from the dose of steroids. These risk factors may assume greater significance when the total dose of steroids is not very high, as in the case of inhalational steroids.
Our finding of a significant decrease in BMD in only the female patients and not the male patients was in line with the known predisposition of the female, excluding the effect of menopause, to the osteopenic effect of glucocorticoids. However, the number of male patients was small, and by comparison a smaller effect may not be evident. The additional findings of correlations of a greater decrease in BMD of some regions with lower BMI and higher average daily inhaled steroid dose suggest that these are important risk factors in the development of osteopenia with the use of inhaled steroids.