Effect of inhaled corticosteroids on forearm bone mineral density: the HUNT study, Norway.
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.
Langhammer
Arnulf
A
HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Neptunveien 1, 7650 Verdal, Norway. arnulf.langhammer@ntnu.no
Forsmo
Siri
S
Lilleeng
Solfrid
S
Johnsen
Roar
R
Bjermer
Leif
L
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
D000305:Adrenal Cortex Hormones