Inhaled Corticosteroids Reduce Bone Mineral Density in Early Postmenopausal but Not Premenopausal Asthmatic Women

Fujita, Kimie; Kasayama, Soji; Hashimoto, Jun; Nagasaka, Yukio; Nakano, Naoki; Morimoto, Yoshihiro; Barnes, Peter J.; Miyatake, Akihiko

doi:10.1359/jbmr.2001.16.4.782

Cited by 67 publications

(29 citation statements)

References 30 publications

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“…In conclusion, many studies have reported unfavourable systemic effects of ISC, although they are the mainstay of long-term asthma treatment [3][4][5]. In contrast, we were able to show that carotid atherosclerosis was less severe in asthmatic patients treated with ICS than in control subjects.…”

Section: Discussioncontrasting

confidence: 52%

“…Besides the direct inhibitory effects of corticosteroids on the expression of vascular adhesion molecules [10,11], they also show acute cardiovascular effects through nontranscriptional activation of endothelial nitric oxide synthase [31]. Relatively small amounts of ICS are absorbed into the circulation, which sometimes results in hypothalamic-pituitary-adrenal axis suppression, abnormal bone metabolism and cataracts [4,5]. There is no information about the effects of ICS on the cells that make up vessel walls.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with orally or parenterally administered corticosteroids, ICS are thought to have little effect on tissues other than the airways. However, there is growing concern about systemic absorption and possible adverse systemic effects of ICS [3], which may include suppression of the pituitary-adrenal axis, reduced bone density, increased fracture risk, disturbed growth in children, and cataracts [4,5]. Most of these effects have been shown to be dependent on ICS dosage.…”

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confidence: 99%

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Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Otsuki¹,

Miyatake²,

Fujita³

et al. 2010

Eur Respir J

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Although inflammation is an important component of atherosclerosis, it is unknown whether inhaled corticosteroids (ICS) as anti-inflammatory drugs prevent atherosclerosis.In the present study, carotid atherosclerosis was evaluated by ultrasonography in 150 asthmatic patients who had been regularly treated with ICS, and in 150 matched nonasthmatic controls, with an assessment of atherosclerotic risk factors.Carotid intima-media thickness was significantly lower in the asthmatic patients than in the controls. The prevalence of carotid plaque tended to be lower in the asthmatic patients than in the controls. Defined carotid atherosclerosis was diagnosed in 51 of the asthmatic patients, who were older, with a higher prevalence of males, a higher prevalence of dyslipidaemia and a lower mean daily dose of ICS than the 99 patients without carotid atherosclerosis. Stepwise multiple logistic regression analysis identified age, male sex and dyslipidaemia as positive risk factors for carotid atherosclerosis. The mean daily dose of ICS was a negative risk factor.Carotid atherosclerosis is reduced in asthmatic patients treated with ICS compared with matched controls. This study suggests that ICS may have protective effects against atherosclerosis.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Otsuki¹,

Miyatake²,

Fujita³

et al. 2010

Eur Respir J

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“…Prior fractures are important risk factors for low BMD and fracture in adults (31,32), and the long-term use of corticosteroid inhalers in the treatment of asthma is associated with bone loss in a dose-related fashion (33)(34)(35)(36)(37). However, the effect of long-term therapy of ICS on bone mass in children and youth is controversial.…”

Section: Discussionmentioning

confidence: 99%

Normative Bone Mineral Density Z-Scores for Canadians Aged 16 to 24 Years: The Canadian Multicenter Osteoporosis Study

Zhou

Langsetmo

Berger

et al. 2010

Journal of Clinical Densitometry

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The objectives of the study were to develop bone mineral density (BMD) reference norms and BMD Z-scores at various skeletal sites, to determine whether prior fracture and/or asthma were related to BMD, and to assess possible geographic variation of BMD among Canadian youth aged 16-24 yr. Z-Scores were defined as the number of standard deviations from the mean BMD of a healthy population of the same age, race, and sex. Z-Scores were calculated using the reference sample defined as Canadian Caucasian participants without asthma or prior fracture. Reference standards were created for lumbar spine (L1-L4), femoral neck, total hip, and greater trochanter, by each year of age (16-24 yr), and by sex. The Z-score norms were developed for groups noted earlier. Mean Z-scores between the asthma or fracture subgroups compared with the mean Zscores in the reference sample were not different. There were minor differences in mean BMD

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“…The BMDin humans decreases with increasing age, with decrease being particularly marked in postmenopausal women. Arecent study has demonstrated that ICS treatments decrease the BMDin postmenopausal women (17). Thus, BMDin older asthmatics, especially women, should be measured regularly and osteoporosis in these patients needs to be treated adequately.…”

Section: Discussionmentioning

confidence: 99%

Effects of Fluticasone Propionate on Bone Mineral Density in Patients with Persistent Bronchial Asthma.

et al. 2002

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Objective To evaluate osteoporosis in asthmatic patients. Methods Bone mineral density (BMD)was measured using three different methods, namely computed X-ray densitometry (CXD), digital image processing (DIP), and dual energy X-ray absorptiometry (DXA). The BMDdata were standardized using the sex-and age-matchedmean value of BMD.Patients One hundred and twenty-eight patients with persistent asthma.Results The standardized BMDexpressed as Z-score in asthmatic patients was significantly lower than the norm (Z-score -0.48±1.17, mean±SD). In patients who had been continuously treated with oral corticosteroids (OCS), the standardized BMDwas significantly lower than that in patients treated without OCS. In addition, the standardized BMDin patients 60 years and over (Z-score -0.71+1.10, mean+SD,n=58) had decreased to a greater extent than the decrease seen in patients under 60 years (Z-score -0.30±1.21, n=70). Moreover, BMDin these older patients decreased after a 6-month treatment protocol involving the use of an inhaled corticosteroid, fluticasone propionate (FP). During the 6 months, the treatment did not affect BMDin patients who were receiving FP for the first time. Although the BMD did not decrease in patients treated with FP without OCS, the BMDin patients treated with both FP and OCSdecreased during the 6 months.Conclusion These results indicate that the continuous administration of OCSin patients with severe persistent asthma, particularly in older patients, may affect BMDin the short term even at a low OCSdose. (Internal Medicine 41: 798-804, 2002)

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Inhaled Corticosteroids Reduce Bone Mineral Density in Early Postmenopausal but Not Premenopausal Asthmatic Women

Cited by 67 publications

References 30 publications

Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Normative Bone Mineral Density Z-Scores for Canadians Aged 16 to 24 Years: The Canadian Multicenter Osteoporosis Study

Effects of Fluticasone Propionate on Bone Mineral Density in Patients with Persistent Bronchial Asthma.

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