Chest
Volume 120, Issue 5, November 2001, Pages 1468-1473
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Clinical Investigations
ASTHMA
Effects of Inhaled Corticosteroid and Short Courses of Oral Corticosteroids on Bone Mineral Density in Asthmatic Patients: A 4-Year Longitudinal Study

https://doi.org/10.1378/chest.120.5.1468Get rights and content

Background

It is not certain whether inhaled corticosteroid (ICS) therapy reduces bone mineral density (BMD) in asthmatic patients. In addition, the potential risk of osteoporosis associated with the rescue use of short courses of oral corticosteroids (SC-OCS) is unclear.

Objective

To evaluate the effect of inhaled beclomethasone dipropionate (BDP) and SC-OCS on BMD in asthmatic patients.

Design

A 4-year longitudinal study.

Method

Lumbar BMD was measured twice by dual-energy x-ray absorptiometry at a mean (± SD) interval of 4.2 ± 0.1 years in 35 asthmatic adults (15 men and 20 postmenopausal women; mean age at the second evaluation, 60.6 ± 11.5 years) who had been treated with BDP and SC-OCS.

Results

The average period of BDP treatment was 7.7 ± 2.2 years (range, 4.8 to 13.0 years) at the second evaluation. During the study period, the daily dose of BDP was 765 ± 389 μg (range, 100 to 1,730 μg), and the frequency of SC-OCS was 1.9 ± 2.7 courses per year (range, 0.0 to 8.9 courses per year). As a whole, lumbar BMD was unchanged during the course of the study, whereas the Z score (ie, the percentage of normal value predicted from age and sex) increased significantly. Changes in BMD and Z scores in patients receiving high doses of BDP (ie, > 1,000 μg/d; n = 9) were not significantly different from those of patients receiving lower doses (ie, ≤ 1,000 μg/d; n = 26). However, patients receiving frequent SC-OCS (ie, > 2.5 courses per year; n = 9) showed a significantly greater loss in BMD and Z score compared with those receiving sporadic courses (ie,≤ 2.5 courses per year; n = 26) (p = 0.002 and p = 0.035, respectively).

Conclusions

ICS therapy per se does not affect BMD, whereas frequent SC-OCS may do so.

Section snippets

Subjects

Of 130 asthmatic patients who took part in our previous cross-sectional evaluation of BMD in 1993,16 17 patients were excluded based on their use of oral corticosteroids (OCSs) for≥ 3 consecutive months during the study period because of the known deleterious effects of continuous OCS treatment on bone.1624 Of the remaining 113 patients, 35 patients (15 men and 20 postmenopausal women) who visited two physicians (K.I. and B.U.) for a regular visit during the 3 months (from November 1997 to

Patient Demographic Data

The demographic data for the 35 patients participating in the second evaluation are shown in Table 1. Since the first evaluation, the average daily BDP dose had increased by 41 ± 268 μg, and the PEF values had increased by 0.9 ± 16.7% predicted.

BMD

The BMD measured at the lumbar spine on the second evaluation (0.893 ± 0.123 g/cm2) was not significantly different from baseline values (0.899 ± 0.125 g/cm2; p = 0.484). The Z score significantly increased from 95.8 ± 17.8% to 98.3 ± 18.4% (p = 0.001).

Discussion

This study investigated the effects of the long-term use of ICSs and periods of SC-OCS on lumbar BMD in asthmatic patients. The observation period (4.2 ± 0.1 years) was the longest ever among similar studies reported.181921 As a whole, BDP treatment (dose, 765 ± 389 μg/d) and SC-OCS (1.9 ± 2.7 courses per year) did not accelerate bone mass loss in the lumbar spine. Patients treated with higher doses of BDP (ie, > 1,000μ g/d) showed no difference in the change of BMD compared with patients

Acknowledgment

Authors thank Hiroyuki Otsuka for the measurement of BMDs.

References (34)

  • Global Initiative for Asthma

    Global strategy for asthma management and prevention: NHLBI/WHO workshop report

    (1995)
  • K Meeran et al.

    Oral and inhaled corticosteroids reduce bone formation as shown by plasma osteocalcin levels

    Am J Respir Crit Care Med

    (1995)
  • JA Leech et al.

    Effects of short-term inhaled budesonide and beclomethasone dipropionate on serum osteocalcin in premenopausal women

    Am Rev Respir Dis

    (1993)
  • AF Wisniewski et al.

    Cross sectional investigation of the effects of inhaled corticosteroids on bone density and bone metabolism in patients with asthma

    Thorax

    (1997)
  • HA Kerstjens et al.

    Effects of short term and long term treatment with inhaled corticosteroids on bone metabolism in patients with airways obstruction

    Thorax

    (1994)
  • GE Packe et al.

    Bone density in asthmatic patients taking high dose inhaled beclomethasone dipropionate and intermittent systemic corticosteroids

    Thorax

    (1992)
  • AK Laatikainen et al.

    Bone mineral density in perimenopausal women with asthma: a population-based cross-sectional study

    Am J Respir Care Med

    (1999)
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