Osteocalcin, Cortisol Levels, and Bone Mineral Density in Prepubertal Children with Asthma Treated with Long-Term Fluticasone Propionate

Abstract

Aims: The objective of this study is to determine the effects of the long-term treatment with inhaled fluticasone propionate on osteocalcin, cortisol levels, and bone mineral status in children with asthma. Methods: This cross-sectional study examined 230 prepubertal children with asthma (aged 6–11) who had intermittently used inhaled fluticasone propionate for at least 5 years at a mean daily dose of 200 µg (range: 200–350 µg). Serum osteocalcin, cortisol, and bone mineral density (BMD) of the lumbar spine were obtained from each participant. The control group consisted of gender- and age-matched children (n = 170) who were newly diagnosed with asthma and who were not being treated with corticosteroid. Results: The average age (±SEM) was 8.9 ± 0.7 years, their mean (±SEM) daily steroid dose was 180.3 ± 55.0 µg, with 236.5 ± 17.2 g total steroid use during treatment. Between the study and the control groups, no significant differences were observed in cortisol, osteocalcin levels, and BMD (p > 0.05). Conclusion: Long-term treatment with inhaled fluticasone propionate (100 µg twice daily) revealed no negative effects on serum osteocalcin, cortisol levels, and BMD in children with asthma.

Inhaled corticosteroids and bone mineral density at school age: A follow‐up study after early childhood wheezing

“…The authors concluded that changes in BMD interact with changes in height, which means that monitoring children's heights gives an approximation of the effects of ICS on bone . The most recent cross‐sectional study including retrospective follow‐up time did not find a difference in lumbar BMD in pre‐pubertal children using intermitted fluticasone with 200 µg mean daily dose for 5 years compared with newly diagnosed asthmatic children with no history of ICS medication …”

“…28 The most recent crosssectional study including retrospective follow-up time did not find a difference in lumbar BMD in pre-pubertal children using intermitted fluticasone with 200 mg mean daily dose for 5 years compared with newly diagnosed asthmatic children with no history of ICS medication. 29 Due to the long follow-up time, the median cumulative ICS dose in the present study was higher than in two previous French and Finnish studies. 3,28 In the CAMP study, Danish study and recent Turkish study the ICS dose was higher than the median dose of this study.…”

“…Due to the long follow‐up time, the median cumulative ICS dose in the present study was higher than in two previous French and Finnish studies . In the CAMP study, Danish study and recent Turkish study the ICS dose was higher than the median dose of this study . The high accrual dose up to 1,800 mg of ICS and long follow‐up time might be the reason for positive results in the present study compared with other studies.…”

Quantitative Ultrasound Measurement at the Hand Phalanges Does Not Reveal Skeletal Disturbances in Children With Bronchial Asthma: A Longitudinal Observation

“…In another study, the skeletal status in children with asthma using inhaled fluticasone propionate was assessed by bone mineral density measurement at the lumbar spine and some biochemical markers (osteocalcin and cortisol). 35 Comparisons with healthy controls revealed no significant differences in the analyzed parameters. The same group of authors confirmed later their conclusion about the lack of a negative impact of inhaled glucocorticosteroids on dual-energy x-ray absorptiometric results for the lumbar spine in a larger cohort of asthmatic children.…”

“…Picard et al evaluated the impact of inhaled glucocorticosteroids on the SoS measured at the tibia in 85 children with mild‐to‐moderate asthma and found no deleterious effect of the therapy. In another study, the skeletal status in children with asthma using inhaled fluticasone propionate was assessed by bone mineral density measurement at the lumbar spine and some biochemical markers (osteocalcin and cortisol) . Comparisons with healthy controls revealed no significant differences in the analyzed parameters.…”