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Allergy & Asthma Advocate: Summer 2006
Osteoporosis and asthma medicationsBy Richard Honsinger, MD, MACP, FAAAAI, & Adrian Michael, MD Osteoporosis is when bones lose their density and have an increased risk for fracture. Common osteoporosis fracture sites are hips, pelvis, wrists, upper arms, and the small vertebral bones of the back. A less severe bone loss is termed osteopenia. Postmenopausal women are at the most risk for osteoporosis. Caucasians and Asians are at a higher risk for osteoporosis than African-American women. Other risk factors for osteoporosis are:
Common medical causes of osteoporosis include:
Some less common causes include:
Systemic steroids are a well-known cause of osteoporosis, so doctors try to use the lowest effective dose needed to treat a patient. Some patients with difficult-to-control asthma may require occasional courses of systemic steroids, and if asthma is severe can have frequent exposure to high-dose steroids. Fortunately, when used with care, most patients can use inhaled corticosteroids without much concern for osteoporosis. Inhaled steroids are deposited in the lung and are not swallowed or injected. Inhaled steroids are only found in the blood stream in very low concentration. In usual doses this is not even enough to suppress the bodies normal output of adrenal corticosteroids. Other medications used in asthma such as beta agonists (albuterol), leukotriene inhibitors (montelukast, zafirlukast), zileuton, theophylline, and antihistamines have not been implicated as contributing to osteoporosis. Even so, it is felt that many years of inhaled corticosteroids may contribute to osteoporosis risk. To reduce your risk of osteoporosis, there are a few things you can do:
Consult your physician if you have multiple risk factors for osteoporosis including frequent systemic steroid use. Your physician may need to evaluate your bone density to screen for the disease. This is easily performed with a painless assessment by a bone densitometer that uses a harmless ray (dual photons). If osteoporosis is found on bone density testing, there are several therapeutic options available to improve your bone density. One of the most useful classes of medications is the bisphosphonates. This class of medication works on the natural cycle of bone turnover. This cycle consists of the breakdown and rebuilding of bone. These medications help in osteoporosis by inhibiting the part of the cycle in which bone is broken down. These medications can be used not only in instances where osteoporosis or osteopenia is found, but also in prevention in patients who may require systemic steroid therapy. The use of these medications can reduce fractures in patients with osteoporosis by 17-28%. The bisphosphonates are long-acting drugs (alendronate, risedronate, ibandronate) that can be taken daily, weekly, or monthly by pill. There is even an intravenous preparation (pamidronate) that is given annually. When they are stopped the osteoporosis returns. In addition to the bisphosphonates, there are other medications that may be used in osteoporosis, such as calcitonin, parathyroid hormone, estrogen receptor modulators, and estrogen replacement. These medications are not without their limitations and side effects, and not all have been shown to have better reduction in fractures. Discussion with your physician is recommended to find the best treatment or prevention plan for you.
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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Corticosteroid hormones (steroids) are normally produced in small amounts by your adrenal glands. Steroid preparations have proven to be some of the most useful and effective agents available to control asthma. Inhaled (topical) and systemic (pills, intramuscular injection or intravenous infusion) steroids can be administered. These medications, while helpful in treating asthma, are not without their side effects. One serious side effect of chronic steroid use is osteoporosis.