Bone mineral density in asthmatic women on high-dose inhaled beclomethasone dipropionate

Herrala, Jaakko; Puolijoki, Hannu; Impivaara, Olli; Liippo, K.; Tala, E; Mm, Nieminen

doi:10.1016/8756-3282(94)90309-3

Cited by 75 publications

(24 citation statements)

References 12 publications

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“…The third, prospective study carried out in 19 predominantly postmenopausal women with newly diagnosed asthma treated with BDP 1,000 µg·day -1 for 1 yr, showed no effect on bone density of the lumbar spine or proximal femur as measured by DEXA [53]. This result suggests that moderate doses of inhaled corticosteroids may not have an important effect on bone density over a 1 yr treatment period, even in predisposed patients.…”

Section: Adultsmentioning

confidence: 69%

Effect of inhaled corticosteroids on bones and growth

Efthimiou¹,

Barnes²

1998

Eur Respir J

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Asthma is a chronic inflammatory disease of the airways and current national and international asthma management guidelines advocate the early introduction of inhaled corticosteroids as the most effective anti-inflammatory therapy available [1][2][3][4]. However, inhaled corticosteroids are not entirely devoid of risk and their use in clinical practice entails a judgement that weighs the potential benefits against the risks of treatment [5][6]. The potential for systemic effects of inhaled corticosteroids is considered to be reflected in their activity of suppressing the hypothalamic-pituitary-adrenal (HPA) axis [7]. However, the clinical relevance of such suppression has been questioned [8] and concerns have been raised concerning the possible effects of inhaled corticosteroids on bones [9] and growth [10]. This review examines the effects of inhaled corticosteroids on bone metabolism, bone density and growth in adults and children with asthma, in view of the recent availability of a substantial amount of new information from clinical trials. Effect of corticosteroids on bone metabolismCorticosteroids may lead to a reduction in bone mass and osteopenia via several different mechanisms, including direct effects on bone formation and bone resorption and indirect effects via actions on the pituitary-gonadal and pituitary-adrenal axes, intestinal calcium absorption, renal tubular calcium reabsorption and secondary hyperparathyroidism ( fig. 1) [11]. A number of biochemical markers have been used to assess the short-term effects of inhaled corticosteroids on bone turnover [12] (table 1). Bone formation has been evaluated by measuring blood concentrations of bone-specific alkaline phosphatase, osteocalcin and procollagen type-1 carboxy-terminal and amino-terminal propeptides (P1CP and P1NP, respectively). Bone resorption has been evaluated by measuring urinary excretion of hydroxyproline, calcium and pyridinium cross-links and by serum levels of type-1 carboxy-terminal telopeptide (1CTP) and tartrate-resistant acid phosphatase. Examination of relevant retrospective and prospective data, involving 11 studies (1,240 patients) on biochemical bone markers and 14 studies (373 patients) on bone density over a wide dose range, have largely indicated no significant or clinically important effect on these measurements in adults or children with asthma. Markers of bone formation and resorption need to be measured concurrently for a reliable assessment of bone turnover to be made.Knemometry, measuring lower leg growth rate, is a sensitive technique for comparing the systemic activity of different inhaled corticosteroids, but does not relate to long-term growth. The majority of approximately 40 studies on inhaled corticosteroids and statural growth in children, over a wide recommended dose range, including a number of recent long-term, prospective studies, demonstrate little or no effect. Children taking above recommended doses of inhaled corticosteroids should have their growth monitored using stadiometry at least every 6 month...

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Section: Adultsmentioning

confidence: 69%

Effect of inhaled corticosteroids on bones and growth

Efthimiou¹,

Barnes²

1998

Eur Respir J

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“…Most previous studies have been cross-sectional in design and have yielded conflicting results [2][3][4][5][6][7][8][9][10]. One longitudinal study in elderly subjects has shown accelerated bone loss in subjects treated with glucocorticosteroids, but only 40 subjects received steroid therapy and it was not possible to distinguish between any effect of inhaled steroids and that of oral therapy [16].…”

Section: Discussionmentioning

confidence: 99%

“…Some crosssectional studies using high doses of inhaled corticosteroids have also reported decreases in bone mineral density (BMD) or biochemical markers of bone formation [2][3][4][5], whereas others have found little or no effect [6][7][8][9][10]. Such studies, however, are subject to confounding by factors such as previous oral steroid treatment, age, sex, and alcohol or tobacco use.…”

mentioning

confidence: 95%

Bone mineral density in patients with chronic obstructive pulmonary disease treated with budesonide Turbuhaler®

Johnell

Pauwels²,

Löfdahl

et al. 2002

Eur Respir J

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There is a need for studying the effects of long-term inhaled corticosteroid therapy on bone mineral density (BMD) and vertebral fracture rates in patients with mild chronic obstructive pulmonary disease (COPD).Patients (n=912, mean age 52 yrs) with mild COPD (mean forced expiratory volume in one second (FEV1) 77% of predicted; mean FEV1/slow vital capacity ratio 62%) were randomized to receive budesonide 400 mg, or placebo twice daily via Turbuhaler1. BMD was measured at the L2-L4 vertebrae and the femoral neck, trochanter and Ward9s triangle by dual-energy X-ray absorptiometry at baseline and after 6, 12, 24 and 36 months (n=161). Radiographs of the thoracic and lumbar spine were obtained at the beginning and end of treatment (n=653).Previous fractures were present at baseline in 43 budesonide-treated patients (13.4%) and 38 placebo-treated patients (11.5%). New fractures occurred in five budesonidetreated patients, compared with three in the placebo group (p=0.50). There were no significant changes in BMD at any site in budesonide-treated patients, compared with the placebo group, during the course of the study. Budesonide treatment was associated with a slight but statistically significant decrease in the area under the concentrationtime curve for serum osteocalcin.In the present study, involving a large group of patients with chronic obstructive pulmonary disease, long-term treatment with budesonide 800 mg?day -1 via Turbuhaler1 had no clinically significant effects on bone mineral density or fracture rates.

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“…Short-term use of glucocorticoids, frequently prescribed for allergy or asthma exacerbations, is usually not related to bone loss, but chronic use of inhaled glucocorticoid may be absorbed and cause bone loss [13][14][15][16][17].…”

Section: Glucocorticoid Actions On Bone Cellmentioning

confidence: 99%

Medication-induced osteoporosis

Weng¹,

Lane

2007

Curr Osteoporos Rep

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Osteoporosis, a condition of low bone mass and microarchitectural deterioration, results in fractures with minimal trauma. Secondary osteoporosis is defined as bone loss resulting from either specific clinical disorders or medications. Some medications that can induce osteoporosis are discussed. Specifically, this article reviews the pathogenesis of glucocorticoid-induced bone loss and demonstrates the means to successfully manage the condition with a combination of calcium and vitamin D supplementation and, depending on the severity of the bone loss, bisphosphonates or parathyroid hormone. In addition, the pathophysiology of bone loss from aromatase inhibitors in women, gonadotropin-releasing hormone agonists in men, anticonvulsant medications, and proton pump inhibitors is outlined. Finally, this review offers suggestions on evaluation and management of bone health in individuals treated with these medications for prolonged times.

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Bone mineral density in asthmatic women on high-dose inhaled beclomethasone dipropionate

Cited by 75 publications

References 12 publications

Effect of inhaled corticosteroids on bones and growth

Effect of inhaled corticosteroids on bones and growth

Bone mineral density in patients with chronic obstructive pulmonary disease treated with budesonide Turbuhaler®

Medication-induced osteoporosis

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