title: Is there an association between inhaled corticosteroids and bone density in postmenopausal women?
abstract: BACKGROUND
  During the last decades, there has been increased concern about the association between oral corticosteroid (OC) therapy and osteoporosis.
  
  
  OBJECTIVE
  The question currently discussed is whether inhaled corticosteroids (ICs) in recommended doses have any clinically relevant effects on bone mineral density (BMD).
  
  
  METHODS
  We compared BMD in postmenopausal women exposed to corticosteroids only in inhaled form (IC group, n = 106) with that in women not exposed to corticosteroids (unexposed group, n = 674). BMD was also studied in 49 women exposed to OCs, intra-articular injections, or both in addition to ICs (OC group). The women were recruited from a population-based prospective cohort study.
  
  
  METHODS
  We used a dietary survey, bone density measurement of the forearm, and a health questionnaire including an interview about past and present medication use.
  
  
  RESULTS
  Mean BMD did not significantly differ between the IC group (0.434 g/cm2) and the unexposed group (0.429 g/cm2). The mean duration and dose of ICs was 8.2 +/- 5.03 years and 853 microg daily. Within the IC group, BMD stratified for cumulative dose of IC, duration, or current dose greater than or less than 1000 microg did not differ. BMD in the OC group was lower than that in the IC group (0.408 vs 0.434 g/cm2).
  
  
  CONCLUSIONS
  No difference in BMD was noted between the IC group and unexposed control subjects, nor was any dose-response relationship observed between IC therapy and BMD.
authors.affiliation: Division of Geriatric Medicine, Department of Community Medicine, Lund University, Sweden.
authors.forename: Sölve
authors.initials: S
authors.lastname: Elmståhl
authors.forename: Henrik
authors.initials: H
authors.lastname: Ekström
authors.forename: Herbert
authors.initials: H
authors.lastname: Galvard
authors.forename: Olof
authors.initials: O
authors.lastname: Johnell
authors.forename: Maria
authors.initials: M
authors.lastname: Gerhardsson de Verdier
authors.forename: Ensio
authors.initials: E
authors.lastname: Norjavaara
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000503:physiopathology*; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones