Effect of beclomethasone dipropionate on bone mineral content assessed by X-ray densitometry in asthmatic children: a longitudinal evaluation

Baraldi, Eugenio; Bollini, MC; Marchi, Antonietta; Zacchello, Franco

doi:10.1183/09031936.94.07040710

Cited by 75 publications

(40 citation statements)

References 21 publications

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“…We could not obtain measurements of bone mineral density in this study. Several studies have reported that children using inhaled corticosteroids have bone mineral density comparable to that of controls [3,4,5,6,7,8,9,10,11]. A randomised clinical study of 1000 children with mild to moderate asthma found similar changes in bone mineral density in the children on budesonide and placebo [11].…”

Section: Discussionmentioning

confidence: 91%

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Are inhaled corticosteroids associated with an increased risk of fracture in children?

et al. 2004

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Inhaled corticosteroids are widely used in the long-term management of asthma in children. Data on the relationship between inhaled corticosteroid therapy and osteoporotic fracture are inconsistent. We address this issue in a large population-based cohort of children aged 4-17 years in the UK (the General Practice Research Database). The incidence rates of fracture among children aged 4-17 years taking inhaled corticosteroids (n=97,387), taking bronchodilators only (n=70 984) and a reference group (n=345,758) were estimated. Each child with a non-vertebral fracture (n=23,984) was subsequently matched by age, sex, practice, and calendar time to one child without a fracture. Fracture incidence was increased in children using inhaled corticosteroids, as well as in those receiving bronchodilators alone. With an average daily beclomethasone dose of 200 lg or less, the crude fracture risk relative to nonusers was 1.10 [95% confidence interval (CI), 0.96-1.26]; with dosage of 201-400 lg, it was 1.23 (95% CI, 1.08-1.39); and with dosages over 400 lg, it was 1.36 (95% CI, 1.11-1.67). This excess risk disappeared after adjustment for indicators of asthma severity. The increased risk of fracture associated with use of inhaled corticosteroids is likely to be the result of the underlying illness, rather than being directly attributable to inhaled corticosteroid therapy.

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Section: Discussionmentioning

confidence: 91%

“…Inhaled corticosteroid treatment may be associated with normal or reduced bone mass in children [3,4,5,6,7,8,9,10,11,12]. Suppression of bone turnover has been demonstrated only for some markers of formation and resorption in children receiving inhaled steroids [13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Are inhaled corticosteroids associated with an increased risk of fracture in children?

et al. 2004

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“…However, there are no data to suggest that long-term treatment with inhaled corticosteroids is associated with an increased risk of fractures. Reduction in bone density in patients with asthma treated with high doses of inhaled corticosteroids for at least 6 months has been shown in some retrospective studies in adults [26,41,42], but not in others in either adults [43][44][45][46] or children [47][48][49] (table 3). One retrospective study demonstrated there were no significant differences in bone density between patients with asthma who were and those who were not on inhaled steroids, although cumulative inhaled steroid dose was associated with a small reduction in lumbar spine bone density in women [50].…”

Section: Effect Of Corticosteroids On Bone Densitymentioning

confidence: 99%

“…In the only longitudinal study in children [47], lumbar vertebral bone density measured by DEXA was assessed in 14 asthmatic subjects, mean age 9.1 yrs, taking BDP in doses between 300 to 400 µg·day -1 for 6 months. A control group of 16 age-and sex-matched asthmatic children not taking corticosteroids were also studied.…”

Section: Childrenmentioning

confidence: 99%

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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“…114 Three further studies conducted in children have shown that doses of BDP and BUD up to 800 µg/day did not affect bone density, 115,116 and the lumbar spine density of children receiving BDP 300-400 µg/day for 6 months was not different from that of the control group. 117 Overall, the long-term consequences of administering ICS for many decades from early childhood are not known.…”

Section: Adverse Eventsmentioning

confidence: 99%

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years

Main¹,

Shepherd²,

Anderson³

et al. 2008

Health Technol Assess

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Effect of beclomethasone dipropionate on bone mineral content assessed by X-ray densitometry in asthmatic children: a longitudinal evaluation

Cited by 75 publications

References 21 publications

Are inhaled corticosteroids associated with an increased risk of fracture in children?

Are inhaled corticosteroids associated with an increased risk of fracture in children?

Effect of inhaled corticosteroids on bones and growth

Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years

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