Impact of long-term inhaled corticosteroid therapy on bone mineral density: results of a meta-analysis.
BACKGROUND
The impact of long-term inhaled corticosteroid (ICS) therapy on bone mineral density (BMD) is poorly understood.


OBJECTIVE
To evaluate the impact of long-term ICS use on BMD.


METHODS
Random-effects meta-analysis. Published and unpublished literature were identified by searches of MEDLINE and EMBASE databases and consultation with experts. Studies reporting BMD among adult asthma and chronic obstructive pulmonary disease (COPD) patients using ICS and non-ICS controls were identified. Studies selected for review included at least 1 year of follow-up. Two independent reviewers evaluated studies; data from those meeting specified inclusion criteria were abstracted for inclusion in the meta-analysis.


RESULTS
Fourteen (5.3%) of 266 reviewed studies met specified inclusion criteria. Sufficient data were available to perform meta-analysis on 3 measures for ICS-using patients (lumbar, femoral neck, and major trochanter BMD) and 1 measure (lumbar BMD) for non-ICS-using controls. Using current National Asthma Education and Prevention Program definitions, the majority of studies (12 of 14) included patients receiving moderate to high doses of ICSs. Among ICS users, annual changes from baseline in lumbar, femoral neck, and major trochanter BMD (-0.23%, -0.17%, and +1.46%, respectively) were not statistically significant. Mean changes in lumbar BMD were also not significantly different from controls (-0.02%). Further, annual changes in lumbar BMD were not statistically significant for subgroups of patients with asthma or COPD.


CONCLUSIONS
Long-term use of ICSs in patients with asthma or COPD was not associated with significant changes in BMD.
Exponent, Alexandria, Virginia, USA. mhalpern@exponent.com
Michael T
MT
Halpern
Jordana K
JK
Schmier
Maria D
MD
Van Kerkhove
Michael
M
Watkins
Chris J
CJ
Kalberg
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D001507:Beclomethasone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D019819:Budesonide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000068298:Fluticasone; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D019819:Budesonide; D000068298:Fluticasone; D014222:Triamcinolone Acetonide; D001507:Beclomethasone