Effects of short-term exposure to high-dose inhaled corticosteroids on novel markers of bone metabolism.
OBJECTIVE
Novel assays have been developed for markers of type 1 collagen turnover. The aim of this study was to evaluate the effect of short-term exposure to inhaled corticosteroids on both the novel and conventional markers of bone metabolism.


METHODS
Nine healthy subjects received 2 weeks treatment with inhaled budesonide 800 micrograms per day in week 1, and 1600 micrograms per day in week 2, or fluticasone 750 micrograms per day in week 1 and 1500 micrograms per day in week 2, with a 1-week washout in between. Measurement of carboxy-terminal propeptide of type 1 collagen (PICP), carboxy-terminal telopeptide of type 1 collagen (ICTP), plasma alkaline phosphatase bone isoenzyme, and 24-h urinary calcium excretion were made at baseline and at the end of each 2-week treatment period.


RESULTS
ICTP was significantly reduced following treatment with budesonide but not fluticasone compared with baseline: baseline 4.2 micrograms.l-1 budesonide 3.0 micrograms.l-1, fluticasone 3.6 micrograms.l-1. There were no significant changes in PICP compared with baseline after treatment with budesonide or fluticasone. The ratio of PICP:ICTP increased significantly after treatment with both budesonide and fluticasone compared with baseline: baseline 27.4, budesonide 43.7, t 42.6. There were no significant differences between the two treatments for any of the measured parameters.


CONCLUSIONS
Thus, when using sensitive markers of collagen turnover, short-term inhaled corticosteroid therapy was found paradoxically to reduced bone resorption.
Grove
A
A
Department of Clinical Pharmacology, University of Dundee, Ninewells Hospital and Medical School, UK.
McFarlane
L C
LC
Jackson
C M
CM
Lipworth
B J
BJ
D000280:Administration, Inhalation; D000328:Adult; D000704:Analysis of Variance; D000730:Androstadienes / Q000008:administration & dosage / Q000494:pharmacology*; D015415:Biomarkers; D001842:Bone and Bones / Q000187:drug effects* / Q000378:metabolism; D019819:Budesonide; D018592:Cross-Over Studies; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000378:metabolism*; D011282:Pregnenediones / Q000008:administration & dosage / Q000494:pharmacology*; D011347:Procollagen / Q000378:metabolism*
D000730:Androstadienes; D015415:Biomarkers; D005938:Glucocorticoids; D010446:Peptide Fragments; D011282:Pregnenediones; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide; D019819:Budesonide; D000068298:Fluticasone