Inhaled glucocorticoids cause bone loss
Inhaled glucocorticoid therapy leads to a dose-related
loss of bone at the hip, American researchers reveal.
Dr Elliot Israel, department of medicine, Brigham
and Women’s Hospital and Harvard Medical School, and colleagues say
that results of previous studies examining this effect have been inconsistent.
They investigated the effect of inhaled triamcinolone in 109 premenopausal
women with asthma. The women were divided into three groups: those not
taking inhaled glucocorticoids, those taking four to eight puffs per day
and those taking more than eight puffs per day. Steroid use was recorded
by monthly diaries and bone density was measured at baseline and after
six months, one, two and three years. The researchers found that inhaled
glucocorticoid therapy was associated with a dose-related decline in bone
density at both the hip and the trochanter (part of the thigh bone). No
effect was seen at the femoral neck and spine. Each additional puff of
inhaled glucocorticoid was associated with a decline in bone density of
0.00044g/cm2 per year. In a woman treated with 1,200µg
triamcinolone (six puffs twice a day) from the age of 30 years, this equates
to a bone mass at the trochanter 0.106g/cm2 less than the expected
figure at the age of 50 years. This degree of bone mass loss has been
associated with a risk of hip fracture more than twice that among normal
women aged 65 years or older, they comment.
The researchers conclude that the findings have
potentially important clinical implications. Although the study is restricted
to a single inhaled glucocorticoid, all currently available preparations
have dose-related systemic effects so it is likely that these results
can be applied to any of them, they say. However, different inhaled glucocorticoids
might have varying degrees of effect. They suggest: “When used to treat
asthma, inhaled glucocorticoids should be used at the lowest dose necessary
to achieve control of symptoms.” (New England Journal of Medicine 2001;345:941.)
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