Inhaled corticosteroid-related tooth problems in asthmatics.
BACKGROUND
The recent Global Initiative for Asthma guideline states that inhaled corticosteroids (ICSs) may induce osteoporosis as a systemic adverse effect. New ICSs, such as fluticasone propionate, have a high topical potency and may therefore induce tooth problems as a result of direct exposure without hepatic metabolism more frequently than older ICSs.


OBJECTIVE
We evaluated asthma patients who underwent long-term treatment with a new ICS to determine if they had tooth problems that were related to osteoporosis of the mandible.


METHODS
When the conventional bone mineral density (BMD) of asthmatics that received the ICS treatment for at least one year was measured using dual-energy X-ray absorptiometry, the BMD of the mandible was also measured. The T-score of the mandible BMD was then determined based on the mean BMD +/- the standard deviation of normal young adults.


RESULTS
Asthma patients with tooth loss (n = 36) and with caries or other tooth problems (n = 28) were found to have a significantly higher prevalence of osteoporosis in the mandible than those without tooth problems (n = 17; 22.2%, 7.1%, 0%, respectively; chi(2) = 6.34, p < 0.05). In addition, the presence of mandibular osteoporosis (odds ratio: 6.14, p = 0.02) and a T-score of < -1.0 for the femoral neck (odds ratio: 3.25, p = 0.01) were found to be significant risk factors for tooth loss in the asthma patients. Finally, the T-score of the mandible was found to be correlated with age (r = -0.316, p < 0.01), and with the T-scores of the lumbar spine (r = 0.413, p < 0.001) and femoral neck (r = 0.446, p < 0.001).


CONCLUSIONS
Tooth loss in asthma patients undergoing long-term treatment with a topically potent ICS was found to be related to a decrease in BMD, especially in the mandible. Therefore, patients using these types of ICS should have their mandibular BMD checked regularly, especially if they have any risk factors for osteoporosis. In addition, it would be wise for such patients to reduce their ICS dose.
Han
Eui-Ryoung
ER
Department of Allergy, Chonnam National University Medical School, Gwangju, Korea.
Choi
Inseon S
IS
Kim
Hee-Kyung
HK
Kang
Yong-Woon
YW
Park
Jin-Gyoon
JG
Lim
Jeong-Ran
JR
Seo
Jae-Hyun
JH
Choi
Jong-Hun
JH
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D001249:Asthma / Q000150:complications / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects; D005260:Female; D005272:Femur Neck / Q000737:chemistry; D006801:Humans; D008159:Lumbar Vertebrae / Q000737:chemistry; D008297:Male; D008334:Mandible / Q000737:chemistry; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology; D012138:Respiratory Therapy; D012307:Risk Factors; D012737:Sex Factors; D014076:Tooth Diseases / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D016388:Tooth Loss / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
D000305:Adrenal Cortex Hormones