Inhaled corticosteroid use and bone-mineral density in patients with asthma

Wong, Conroy; Walsh, L J; Smith, Christopher J.; Wisniewski, A; Lewis, Sarah; Hubbard, Richard; Cawte, S. A.; Green, Desmond J.; Pringle, Michael; Tattersfield, Anne E.

doi:10.1016/s0140-6736(00)02138-3

Cited by 320 publications

(89 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Wong et al [20], however, recently showed a fall in spinal BMD in asthmatic patients as the cumulative dose of inhaled GC increased. In the present study, the smaller cumulative dose may explain why a negative effect of inhaled GC on bone density was not demonstrated.…”

Section: Discussionmentioning

confidence: 97%

Oral Glucocorticoid-Induced Fall in Cortical Bone Volume and Density in Postmenopausal Asthmatic Patients

et al. 2001

View full text Add to dashboard Cite

Despite a deepening understanding of the influence of glucocorticoids (GC) on trabecular bone, little is known about GC-induced cortical bone loss. To elucidate the mechanism of GC-induced loss of cortical bone strength with particular reference to cortical bone loss, changes in cortical density, relative cortical volume, and the Strength Strain Index (SSI) based on biomechanical analyses of the geographic distribution of cortical bone material were measured. These parameters were compared, using peripheral quantitative computed tomography (pQCT), among the following age-matched groups: 68 postmenopausal asthmatic patients receiving high-dose oral GC in addition to inhaled GC (oral GC group), 68 postmenopausal asthmatic patients receiving only inhaled GC (inhaled GC group) and 69 postmenopausal controls without asthma or GC therapy (control group). Cortical bone mineral density (BMD) was measured, relative cortical volume was obtained by dividing the cortical area by the total bone area using pQCT (Stratec XCT960), and the Strength Strain Index (SSI) was calculated in the radius based on the density distribution around the axis. Spinal fracture was assessed on lateral radiographs. The number of vertebral fractures per patient correlated highly with cortical BMD, relative cortical volume and SSI values at the radius. The number of vertebral fractures per patient and the number of patients with fracture were similar between the control and inhaled GC group, both being significantly lower than those in the oral GC group. Total BMD, trabecular BMD, cortical BMD, relative cortical volume and SSI were similar between the first two, being significantly higher than in the last group. The slopes of cortical volume-density relationship, however, were identical among the three groups, indicating the persistence of cortical bone remodeling and a similar degree of calcification regardless of GC administration.

show abstract

Section: Discussionmentioning

confidence: 97%

Oral Glucocorticoid-Induced Fall in Cortical Bone Volume and Density in Postmenopausal Asthmatic Patients

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Adverse systemic effects of inhaled corticosteroids include loss of glycemic control [96], cataracts [97], skin bruising [98], adrenal suppression [99], and osteoporosis [100]. Inhaled corticosteroids are also associated with an increased risk of pneumonia [101,102].…”

Section: Polypharmacy Compliance and Drug Averse Events In The Elderlymentioning

confidence: 99%

Do We Need Different Treatments for Very Elderly COPD Patients?

Valente¹,

Pasciuto²,

Bernabei³

et al. 2010

Respiration

View full text Add to dashboard Cite

Population ageing is a new challenge for physicians because of the clinical complexity of the elderly. Although geriatric pharmacology is an emerging issue, very little is known and the choice of different treatments for the very elderly is still an important question. Chronic obstructive pulmonary disease is one of the most common chronic diseases throughout the world affecting prevalently older people. Despite the increasing burden of chronic obstructive pulmonary disease in older people, underdiagnosis and undertreatment in this age group are still common problems. Some patients are frail as they have impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve. Pharmacotherapeutic decisions should be combined with a careful assessment of comorbidity, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions, and nonadherence to treatment. There are few studies that specifically examine age as a factor influencing the pharmacokinetics and pharmacodynamics of inhaled therapies, the cornerstone of treatment for chronic obstructive pulmonary disease. This review provides a summary of age-related physiological changes and their impact on pharmacokinetics and pharmacodynamics, with particular regard to the drugs implicated in chronic obstructive pulmonary disease treatment, in order to optimize drug therapy.

show abstract

“…In terms of their effects on BMD, conflicting data have been reported concerning the correlation with the total cumulative dose [27,28]. In a British study by Wong et al [27], the use of 2000 µg/d of BDP or equivalent for 7 years resulted in a reduction in BMD of at least one standard deviation.…”

Section: Systemic Effectsmentioning

confidence: 99%

The dose-response relationship of inhaled corticosteroids in asthma

Masoli

Holt

Weatherall

et al. 2004

Curr Allergy Asthma Rep

View full text Add to dashboard Cite

Inhaled corticosteroids are the only class of asthma medication that can reduce symptoms, improve lung function, reduce the frequency of severe exacerbations, including hospital and ICU admissions, and decrease the risk of mortality. The therapeutic dose range for all clinical outcome measures in adults is 100 to 1000 mg/d of beclomethasone dipropionate or budesonide, or 50 to 500 mg/d of fluticasone propionate. Doses in excess of this range are not recommended for routine use because they are likely to increase the risk of systemic side-effects without further major improvement in efficacy. The recommendations are qualified by the recognition that there is considerable individual variability in the response to inhaled corticosteroids in asthma, which would suggest that some patients might obtain greater benefit at higher doses, just as some might obtain maximum benefit at lower doses.

show abstract

Inhaled corticosteroid use and bone-mineral density in patients with asthma

Cited by 320 publications

References 25 publications

Oral Glucocorticoid-Induced Fall in Cortical Bone Volume and Density in Postmenopausal Asthmatic Patients

Oral Glucocorticoid-Induced Fall in Cortical Bone Volume and Density in Postmenopausal Asthmatic Patients

Do We Need Different Treatments for Very Elderly COPD Patients?

The dose-response relationship of inhaled corticosteroids in asthma

Contact Info

Product

Resources

About