Background: Previous studies provide conflicting evidence about whether use of inhaled corticosteroids to treat asthma is associated with reduced bone mineral density. Methods: We studied the dose response relationship between cumulative inhaled corticosteroid use and bone mineral density at the lumbar spine and hip in 196 adults (119 women) with asthma aged 20 to 40 in a community based cross-sectional survey. All patients had taken an inhaled corticosteroid regularly for at least 6 months with limited exposure to systemic steroids in the past. Data on current and past medication use were obtained from computer and written records in general practice and by questionnaire. Bone mineral density was measured at the lumbar spine and left femur by dual photon absorptiometry. Results: Multiple regression of cumulative dose of inhaled corticosteroid on bone mineral density showed negative independent associations at the lumbar spine (L2-L4), femoral neck and Ward's triangle. A 1000 μg/day increase in inhaled corticosteroid dose for a year (1000 [μg/day].year) was independently associated with a reduction in bone mineral density of 0.010 g/cm2 (95% confidence interval, -0.019 to -0.022, p=0.013) at the lumbar spine (L2-L4), after adjustment for the effects of age, sex and cumulative oestrogen dose. The corresponding changes at the femoral neck and Ward's triangle were 0.008 g/cm2 (-0.017 to -0.0001, p=0.048) and 0.011 g/cm2 (-0.020 to -0.003, p=0.012) respectively. The effect was not reduced by adjustment for a number of confounding factors including past oral corticosteroid use, physical activity, and lung function. Conclusions: This large study suggests that inhaled corticosteroid use is associated with a reduction in bone mineral density at the spine and hip of around 0.01 g/cm2 per 1000 μg per year.
|Issue number||SUPPL. 4|
|Publication status||Published - Dec 1998|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine