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Previous Volume 345:941-947 September 27, 2001 Number 13 Next

	Full Text PDF Editorial by Dawson-Hughes, B. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Kerwin, E. PubMed Citation

ABSTRACT

Background Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term therapy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we examined the relation between the dose of inhaled glucocorticoids and the rate of bone loss in premenopausal women with asthma.

Methods We studied 109 premenopausal women, 18 to 45 years of age, who had asthma and no known conditions that cause bone loss and who were treated with inhaled triamcinolone acetonide (100 µg per puff). We measured bone density by dual-photon absorptiometry at base line, at six months, and at one, two, and three years. Serum osteocalcin and parathyroid hormone and urinary N-telopeptide, cortisol, and calcium excretion were measured serially. We measured inhaled glucocorticoid use by means of monthly diaries, supported by the use of an automated actuator-monitoring device.

Results Inhaled glucocorticoid therapy was associated with a dose-related decline in bone density at both the total hip and the trochanter of 0.00044 g per square centimeter per puff per year of treatment (P=0.01 and P=0.005, respectively). No dose-related effect was noted at the femoral neck or the spine. Even after the exclusion of all women who received oral or parenteral glucocorticoids at any time during the study, there was still an association between the decline in bone density and the number of puffs per year of use. Serum and urinary markers of bone turnover or adrenal function did not predict the degree of bone loss.

Conclusions Inhaled glucocorticoids lead to a dose-related loss of bone at the hip in premenopausal women.

Source Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine (E.I., T.R.B.), and the Skeletal Health and Osteoporosis Program, Division of Endocrinology–Hypertension (M.S.L.), Brigham and Women's Hospital and Harvard Medical School; the Departments of Biostatistics (G.M.F.) and Environmental Health (T.V.K.), Harvard School of Public Health; and the Department of Internal Medicine, Harvard Pilgrim Health Care (K.L.) — all in Boston.

Address reprint requests to Dr. Israel at the Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at eisrael{at}partners.org.

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