Fluticasone propionate does not influence bone metabolism in contrast to beclomethasone dipropionate.

Bootsma, Gerben; Dekhuijzen, P.N.R.; Festen, J.; Mulder, Paul; Swinkels, L.M.J.W.; Herwaarden, C.L.A. van

doi:10.1164/ajrccm.153.3.8630574

Cited by 68 publications

(42 citation statements)

References 25 publications

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“…Indices of bone formation, such as alkaline phos phatase (AP) or the bone-specific isoenzyme of AP, were not altered by ICS in most studies [25][26][27][28][29][30][31]. Only in the study of A li et al were changes found [32].…”

Section: Side-effects: General Considerationsmentioning

confidence: 99%

“…2) [21,[25][26][27][28][29][30][31][35][36][37][38]. Os teocalcin is a very sensitive marker of osteoblast activity, as most serum osteocalcin originates from new cellular synthesis [34].…”

Section: Side-effects: General Considerationsmentioning

confidence: 99%

“…Changes in trabecular bone are better reflected in the concentration of cross-links, and deoxypyridinoline is more specific for osseous tissue than are pyridinoline cross-links [34]. To date, only a few data are available on the effects of ICS on pyridino line excretion in asthmatic patients, showing no changes [31,45]. Altogether, these findings indicate that in general ICS do not increase bone resorption.…”

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

“…2, showing the advantage of ICS. However, when looking at comparative trials between FP in half the dose of BDP, being clinically equipotent [41,42], osteocalcin levels were significantly lowered after the double dose of BDP, with no change after FP [31,43]. Ayres et al [44] compared FP with BUD, but all patients already used 1-2 mg of ICS daily before the study.…”

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

“…Markers of bone resorption, such as excretion of calcium and hydroxyprolines in urine, appeared to be increased in one study [32], but were unaltered in most studies [21,25,26,30,31,33,37]. Other markers of bone resorption include type 1 carboxy-terminal telopeptide (1CTP) and (deoxy)pyridinoline cross links [34,39].…”

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

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Effects of inhaled corticosteroids on bone

Bootsma

Dekhuijzen

Festen

et al. 1997

The Netherlands Journal of Medicine

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Inhaled corticosteroids (ICS) are the most effective therapy for asthma currently available. The increasing use of ICS raises the issue of possible adverse systemic effects. Since one of the most important side-effects of oral corticosteroids (OCS) is osteoporosis, this article focuses on current knowledge of the effects of ICS on bone. Generally, doses higher than 1.0 mg/day cause a dose-dependent decrease in serum osteocalcin levels. Decreases in bone density have been suggested after treatment with ICS, but in most studies it is impossible to quantify the contribution of previous treatment with OCS and other confounding factors to bone loss. The clinical relevance of the observed changes in the long term is unknown. To date,

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Section: Side-effects: General Considerationsmentioning

confidence: 99%

“…2) [21,[25][26][27][28][29][30][31][35][36][37][38]. Os teocalcin is a very sensitive marker of osteoblast activity, as most serum osteocalcin originates from new cellular synthesis [34].…”

Section: Side-effects: General Considerationsmentioning

confidence: 99%

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

Section: Biochemical Markers O F Bone Turnovermentioning

confidence: 99%

See 3 more Smart Citations

Effects of inhaled corticosteroids on bone

Bootsma

Dekhuijzen

Festen

et al. 1997

The Netherlands Journal of Medicine

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Systemic Adverse Effects of Inhaled Corticosteroid Therapy

1999

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Objective: To appraise the data on systemic adverse effects of inhaled corticosteroids.Methods: A computerized database search from January 1, 1966, through July 31, 1998, using MEDLINE, EMBASE, and BIDS and using appropriate indexed terms. Reports dealing with the systemic effects of inhaled corticosteroids on adrenal gland, growth, bone, skin, and eye, and reports on pharmacology and pharmacokinetics were reviewed where appropriate. Studies were included that contained evaluable data on systemic effects in healthy volunteers as well as in asthmatic children and adults. A statistical meta-analysis using regression was performed for parameters of adrenal suppression in 27 studies.Results: Marked adrenal suppression occurs with high doses of inhaled corticosteroid above 1.5 mg/d (0.75 mg/d for fluticasone propionate), although there is a considerable degree of interindividual susceptibility. Metaanalysis showed significantly greater potency for doserelated adrenal suppression with fluticasone compared with beclomethasone dipropionate, budesonide, or triamcinolone acetonide, whereas prednisolone and fluticasone propionate were approximately equivalent on a 10:1-mg basis. Inhaled corticosteroids in doses above 1.5 mg/d (0.75 mg/d for fluticasone propionate) may be associated with a significant reduction in bone density, although the risk for osteoporosis may be obviated by postmenopausal estrogen replacement therapy. Although medium-term growth studies showed suppressive effects with 400-µg/d beclomethasone dipropionate, there was no evidence to support any significant effects on final adult height. Long-term, high-dose inhaled corticosteroid exposure increases the risk for posterior subcapsular cataracts, and, to a much lesser degree, the risk for ocular hypertension and glaucoma. Skin bruising is most likely to occur with high-dose exposure, which correlates with the degree of adrenal suppression.Conclusions: All inhaled corticosteroids exhibit doserelated systemic adverse effects, although these are less than with a comparable dose of oral corticosteroids. Metaanalysis shows that fluticasone propionate exhibits greater dose-related systemic bioactivity compared with other available inhaled corticosteroids, particularly at doses above 0.8 mg/d. The long-term systemic burden will be minimized by always trying to achieve the lowest possible maintenance dose that is associated with optimal asthmatic control and quality of life. Med. 1999;159:941-955 Arch Intern

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