11/10/03 Is inhaled corticosteroid use associated with decreased bone density in post-menopausal women?SummaryThere has been an increasing concern in some quarters about the possible adverse effects of chronic therapy with inhaled corticosteroids (ICS) on bone density, particularly in post-menopausal women. Elmstahl et al of Lund Univ. in Malmo, Sweden carried out a cohort study comparing bone mineral density in post-menopausal women: 1) a group treated chronically with ICS but no oral steroids (n=106); 2) a control group who had never been treated with ICS (n=674); 3) an OC group treated chronically/intermittently with oral steroids and/or intra-intarticular steroid injections. The dietary history and general health of these women were also assessed by questionnaires. The mean duration of ICS use was 8.2¦5.0 years with a mean daily dose of 853 mcg. There was no significant difference in the BMD of those treated with ICS but no oral steroids when compared to those who had not received ICS (0.434 vs 0.429 g/cm2). There was also no inverse relationship of the BMD to the average daily ICS dose in individual patients. In contrast, the mean BMD was significantly lower in the women treated systemically with corticosteroids (0.408¦0.08). There were no significant differences among the 3 study groups in the patterns of life style with regards to other risk factors for osteopenia. Reference J Allergy Clin Immunol 2003; 111:91-6 Editor's Comments The findings in this study are encouraging when considering long-term ICS therapy in post-menopausal women. The latter group is at particular risk for osteopenia with its attendant complications (e.g. - fractures). I would have preferred to see the BMD measured in the spine (an area at particular increased risk for osteopenia) rather than the forearm as carried out in this study. But the findings are still important and relevant. The lack of increased osteopenia in these treated with ICS is particularly impressive considering the relatively high mean daily dose of ICS used for a sizable duration of time in these patients. I usually try to keep the daily dose of ICS at < 400mcg/day for average sized adults (even lower for fluticasone) if at all feasible. It is well known that the therapeutic beneficial effects of ICS in asthma often start to plateau at doses above 800 mcg/day while the possibility of systemic adverse effects keeps increasing with increasing ICS doses.
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