Effects of prednisolone on bone turnover in patients with corticosteroid resistant asthma.
BACKGROUND
Although corticosteroid resistant (CR) bronchial asthma is associated with impaired in vitro an din vivo glucocorticoid (GC) responsiveness in mononuclear cell function, it is not known whether this is a cell specific phenomenon or whether these patients are at risk of glucocorticoid side-effects as corticosteroid-sensitive (CS) subjects. In order to address this question we have examined the effects of GCs on biochemical indices of bone turnover in vivo.


METHODS
Six CS and six CR subjects received prednisolone 40 mg orally at 09.00 daily for 5 days. At 08.30 on day 1 and day 6 a fasting blood was taken for estimation of serum osteocalcin, tartrate resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP; total and bone isoenzyme), and a urine sample taken for estimation of free deoxy-pyridinoline crosslinks. TRAP and ALP were measured by a colorimetric method and osteocalcin and deoxy-pyridinoline crosslinks by ELISA.


RESULTS
Serum osteocalcin (nmol/L) decreased from 1.39 +/- 0.09 (mean +/- SEM) to 1.14 +/- 0.07 (P = 0.023) and from 1.19 +/- 0.05 to 0.96 +/- 0.1 (P = 0.037) in the CS and CR groups respectively. There was no difference between baseline and post-treatment levels in either group. Serum total ALP (units/L) decreased from 178 +/- 7 to 168 +/- 4 (P = 0.02) and from 195 +/- 22 to 175 +/- 16 (P = 0.04) in the CS and CR groups, respectively. There was no difference between baseline and post-treatment levels in either group. There was no significant elevation of deoxy-pyridinoline crosslinks or TRAP and no suppression of bone ALP in either group.


CONCLUSIONS
We suggest that CR asthmatics may be equally at risk from the metabolic side-effects of glucocorticoids.
Department of Allergy and Respiratory Medicine, Guy's Hospital, London, UK.
S J
SJ
Lane
S
S
Vaja
R
R
Swaminathan
T H
TH
Lee
D000135:Acid Phosphatase / Q000097:blood; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000469:Alkaline Phosphatase / Q000097:blood; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001861:Bone Regeneration / Q000187:drug effects*; D001862:Bone Resorption / Q000139:chemically induced; D004351:Drug Resistance; D006801:Humans; D015675:Osteocalcin / Q000097:blood; D011239:Prednisolone / Q000494:pharmacology*
D000305:Adrenal Cortex Hormones; D015675:Osteocalcin; D011239:Prednisolone; D000469:Alkaline Phosphatase; D000135:Acid Phosphatase