title: Effect of inhaled corticosteroids on forearm bone mineral density: the HUNT study, Norway.
abstract: OBJECTIVE
  To study the effect of inhaled corticosteroid (ICS) on bone mineral density (BMD) in an observational longitudinal study.
  
  
  METHODS
  In 1995-97, as part of the Nord-Trøndelag Health Study, Norway, 10,941 subjects aged 20 yr or more, either reporting asthma diagnosis/asthma-related symptoms or randomly selected, were interviewed, underwent spirometry and had their forearm BMD assessed. Among these, 4705 persons were invited to follow-up interview and bone densitometry in 2001; a total of 2848 subjects were eligible for analyses.
  
  
  RESULTS
  Use of corticosteroids for respiratory diseases was reported by 1262 subjects, and 528 subjects had used ICS at both baseline and follow-up. The yearly loss of adjusted forearm distal BMD was higher in those reporting use of ICS at both baseline and follow-up compared to subjects without respiratory symptoms. In women the figures were 3.14 versus 2.26 mg/cm2, whilst in men they were 3.76 versus 1.92 mg/cm2 (both p<0.01). No significant association was found between loss of BMD and neither daily dose nor duration of ICS use. Reduced lung function (forced expiratory flow in 1s) was an independent risk factor for increased bone loss in both sexes.
  
  
  CONCLUSIONS
  ICS users had greater bone loss at the forearm compared to ICS naive persons, but no significant dose-response effect between ICS and BMD was found. Residual confounding by disease severity cannot be ruled out, but even in case of an ICS causal effect, this should have minor clinical significance in most patients using low to moderate doses of ICS.
authors: HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Neptunveien 1, 7650 Verdal, Norway. arnulf.langhammer@ntnu.no
authors: Arnulf
authors: A
authors: Langhammer
authors: Siri
authors: S
authors: Forsmo
authors: Solfrid
authors: S
authors: Lilleeng
authors: Roar
authors: R
authors: Johnsen
authors: Leif
authors: L
authors: Bjermer
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D015519:Bone Density / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones