Medicine of the Future in America

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

For the female patient group, significant correlations were found between the following parameters: average daily dose of inhaled steroids and BMD of the lumbar area of the spine (r= —0.46, p=0.054 [Fig 4]) and the trochanter of femur (r= —0.47, p=0.047); BMI and BMD of the trochanter of femur (r=0.51, p=0.03). There was no correlation between BMI and trochanteric BMD in the female control group.
Osteoporosis is a well-documented side effect of chronic systemic use of corticosteroids. Prolonged systemic steroid use in the treatment of bronchial asthma has been reported to be associated with a decrease in bone mass and an increase in bone fractures.’ There is growing concern about the possible adverse effects of inhaled corticosteroids on bone. Studies about their effect on bone turnover using biochemical indices suggest that they may depress bone formation as evidenced by depressed serum osteocalcin and increase bone resorption as shown by increased hydroxyproline output in urine 2 Studies of their effect on bone mass have yielded conflicting results. Some of the problems encountered included the different methods and skeletal sites used to assess bone mass, the small number of patients in the study uncertainty concerning the effect of intermittent systemic steroid use on bone loss and the use of suboptimally matched control subjects for comparison. generic allegra

Our control subjects were carefully matched for several factors known to potentially affect BMD. Because the control subjects were normal healthy subjects, we cannot exclude the effect of the disease itself on BMD. However, it is practically impossible to find patients with similar degree and duration of asthma who have not been treated with some steroid medications. There are asthmatic subjects with mild cases of the disease who have only had bronchodila-tor treatment, but we thought that if the severity of asthma was not similar the “control” was fallacious, since the major factors that might contribute to a decrease in bone density in asthma per se were immobility and malnutrition in severe illness.

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