Common asthma therapy ups risk of osteoporosis

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Common asthma therapy ups risk of osteoporosis

NEW YORK, Sep 26 (Reuters Health) - Young women who use inhaled steroids

to control their asthma may be putting themselves at risk of developing

osteoporosis and hip fracture over the long term, new study findings

suggest.

The study revealed that inhaled glucocorticoids, or steroids, which are

among the safest and most effective treatments for persistent asthma,

were associated with a loss of bone density in the hip and upper

thighbone, and that higher doses correlated with greater bone loss in

premenopausal women. Bone density in other areas such as the femoral

neck (part of the thighbone between the knob-like head of the femur and

the upper thighbone) and the spine was not affected.

The results indicate that healthcare providers should prescribe the

lowest possible doses of inhaled steroids for premenopausal women with

asthma and take steps to minimize bone loss among patients who receive

higher doses, the researchers report in the September 27th issue of The

New England Journal of Medicine.

" Overall, these findings do not suggest that patients should stop their

steroid inhalers, or tolerate poor asthma control, but rather they

should work with their doctors to find the lowest dose of inhaled

glucocorticoid that can be used to achieve control of their asthma

symptoms, " Dr. Elliot Israel, the study's lead investigator from Harvard

Medical School in Boston, Massachusetts, said in a statement.

Inhaled steroids reduce inflammation in the airways. While steroids

taken orally are known to reduce bone mass, it is unclear whether

steroids taken through an inhaler have the same effect.

To investigate, the researchers measured bone density at various sites

in 109 women aged 18 to 45, over a 3-year period. All women were treated

with a particular steroid, triamcinolone acetonide, with an inhaler that

delivered 100 micrograms of medication per puff.

Women who inhaled more than eight puffs a day experienced more bone loss

than women consuming four to eight puffs daily, and both groups lost

more bone from key areas compared with a group of women who did not take

inhaled glucocorticoids. In fact, each additional puff was associated

with a decline in bone density in certain areas of the skeleton.

In an accompanying editorial, Dr. Bess Dawson- from Boston-based

Tufts University adds that healthcare providers should monitor bone

density in young women taking these medications and recommend

weight-bearing exercise and adequate intake of calcium and vitamin D,

which help to preserve bone.

SOURCE: The New England Journal of Medicine 2001;345:941-947, 989-991.