title: Osteoporosis in the at-risk asthmatic.
abstract: The effect of inhaled glucocorticosteroids (ICS) on bone metabolism and subsequent osteoporosis is controversial. Explanations for this controversy include various study designs, duration of use, outcome measures, and population demographics of research studies with intranasal or inhalational ICS. Patients with poorly controlled asthma are at greatest risk of osteoporosis because they are commonly treated with intermittent or continuous systemic corticosteroids (SCS) or high-dose ICS. A 45-year-old Caucasian woman presents with moderate-to-severe asthma with frequent albuterol use and nighttime awakenings at least once weekly. She is on fluticasone/salmeterol 500/50 μg one inhalation twice daily and montelukast 10 mg/day. She requires prednisone 15 mg three times per day for 5 days up to three times a year. Is this patient at greater risk of osteopenia, characterized by a T-score between -1.0 and -2.5, and subsequent osteoporosis and an increased risk of fractures? If she has osteopenia, should she be treated with a bisphosphonate? The risk of osteoporosis and fracture increases significantly with frequent administration of SCS, and patients on such medications should undergo preventative measures and treatment. This study discuses factors that contribute to an increased risk of osteoporosis/osteopenia in patients with asthma and suggests recommendations based on the current literature.
authors.affiliation: Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Aljubran
authors.forename: G J
authors.initials: GJ
authors.lastname: Whelan
authors.forename: M C
authors.initials: MC
authors.lastname: Glaum
authors.forename: R F
authors.initials: RF
authors.lastname: Lockey
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage; D019587:Dietary Supplements; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use; D015444:Exercise; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D012306:Risk
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D002118:Calcium
keywords: asthma; bisphosphonates; glucocorticoids; osteoporosis