The Skeletal Effects of Inhaled Glucocorticoids.
The skeletal effects of inhaled glucocorticoids are poorly understood. Children with asthma treated with inhaled glucocorticoids have lower growth velocity, bone density, and adult height. Studies of adults with asthma have reported variable effects on BMD, although prospective studies have demonstrated bone loss after initiation of inhaled glucocorticoids in premenopausal women. There is a dose-response relationship between inhaled glucocorticoids and fracture risk in asthmatics; the risk of vertebral and non-vertebral fractures is greater in subjects treated with the highest doses in the majority of studies. Patients with COPD have lower BMD and higher fracture rates compared to controls, however, the majority of studies have not found an additional detrimental effect of inhaled glucocorticoids on bone. While the evidence is not conclusive, it supports using the lowest possible dose of inhaled glucocorticoids to treat patients with asthma and COPD and highlights the need for further research on this topic.
Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA.
Stephanie A
SA
Sutter
Division of Endocrinology, Columbia University College of Physicians & Surgeons, 630 West 168th Street, PH8 West 864, New York, NY, 10032, USA. es2029@columbia.edu.
Emily M
EM
Stein
D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001827:Body Height; D015519:Bone Density; D001846:Bone Development; D002648:Child; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000453:epidemiology*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D010024:Osteoporosis / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*
D005938:Glucocorticoids
Fracture; Glucocorticoids; Inhaled steroids; Osteoporosis; Pulmonary disease