title: Effect of high-dose fluticasone propionate on bone density and metabolism in children with asthma.
abstract: Significant concern remains over the long-term side effects of inhaled steroids. This cross-sectional study evaluates the effect of high-dose inhaled fluticasone propionate (FP) on biochemical markers of bone metabolism and bone density in children with asthma. Children with chronic asthma using FP >/= 1,000 mcg daily for at least 6 months, and healthy controls, were entered in the study. No children had taken oral prednisolone within the previous month. Fasting morning serum was analyzed for bone formation markers, and spot urine for bone resorption markers. Dual-energy X-ray absorptiometry (DEXA) results were reviewed in a subgroup of patients. Forty-nine children with asthma and 32 controls were recruited. The mean FP dose was 771.2 +/- 253.35 mcg/m2/day. Unpaired t-test analysis revealed no significant difference in biochemical markers studied. In subjects with asthma; 13 of 37 (35.1%) had lumbar spine density more than one standard deviation below the mean (P = 0.001). This fell to 6/37 (16.2%) with bone age correction (NS). In conclusion, no significant reduction in bone metabolism or bone age-corrected bone mineral density was observed in children with asthma on prolonged high doses of inhaled FP.
authors.affiliation: Department of Respiratory and Sleep Medicine, Monash Medical Centre, Clayton, and Centre for Heart and Chest Research, Monash University, Melbourne, Australia. agriffiths@paed.uwa.edu.au
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Griffiths
authors.forename: Derrick
authors.initials: D
authors.lastname: Sim
authors.forename: Boyd
authors.initials: B
authors.lastname: Strauss
authors.forename: Christine
authors.initials: C
authors.lastname: Rodda
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Nicholas
authors.initials: N
authors.lastname: Freezer
mesh_terms: D015502:Absorptiometry, Photon; D000280:Administration, Inhalation; D000293:Adolescent; D000730:Androstadienes / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects* / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D015675:Osteocalcin / Q000097:blood; D013256:Steroids / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000730:Androstadienes; D015415:Biomarkers; D001993:Bronchodilator Agents; D013256:Steroids; D015675:Osteocalcin; D000068298:Fluticasone