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

Abstract

Inhaled corticosteroids are widely used in the treatment of bronchial asthma, but it is still uncertain whether long-term use of the inhaled corticosteroids affects bone metabolism in asthmatic patients. In this study, we examined the effect of inhaled beclomethasone dipropionate (BDP) on bone mineral density (BMD) and biochemical markers of bone metabolism in pre-and early postmenopausal asthmatic women. Thirty-six (17 premenopausal and 19 early postmenopausal) asthmatic women and 45 healthy control (24 premenopausal and 21 early postmenopausal) women were investigated. All the asthmatic patients were treated with BDP (542 ؎ 298 g/day; 100-1200 g/day) without any systemic administration of corticosteroids for at least 1 year. In premenopausal women, BMD as well as the biochemical markers of bone metabolism did not differ between control subjects and BDP-treated asthmatic patients. By contrast, in early postmenopausal women, BMD was significantly lower in BDP-treated asthmatic patients than in control subjects. In these early postmenopausal women, serum intact osteocalcin concentration was lower in the BDP-treated asthmatic patients than in the control subjects whereas urinary free pyridinoline (F-PYD) and free deoxypyridinoline (F-DPD) concentrations did not differ between the groups. Thus, early postmenopausal, but not premenopausal, asthmatic patients who were treated with inhaled BDP had reduced BMD, which was associated with a decreased level of the bone formation marker. Ovarian hormones may be protective against the adverse effect of inhaled BDP on bone metabolism in the premenopausal patients. (J Bone Miner Res 2001;16:782-787)

Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

“…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.…”

“…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.…”

“…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.…”

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

“…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.…”

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

“…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.…”