The effect of inhaled corticosteroids on bone mineral density measured by quantitative ultrasonography in an older population.
BACKGROUND
Prolonged use of systemic corticosteroids leads to reduced bone mineral density and osteoporosis, in turn increasing the risk of minimal trauma fractures with their associated morbidity and mortality in elderly populations. However, the effect of inhaled corticosteroids on bone mineral density has been debated in the medical literature.


OBJECTIVE
We aimed to determine the effect of inhaled corticosteroids on bone mineral density measured using calcaneal quantitative ultrasonography in a cohort of older Australians.


METHODS
Data was collected from the Hunter Community Study, a longitudinal cohort of Australians aged 55-85. Simple and multiple linear regression methods were used to test the cross-sectional association between inhaled corticosteroids and calcaneal bone mineral density measured with quantitative ultrasound at baseline. A causal diagram was used to determine the minimally sufficient number of co-variates necessary to determine the unconfounded effect of inhaled corticosteroids on bone mineral density; these included gender, body mass index, smoking, asthma, alcohol use, age, physical activity, and diet.


RESULTS
There were 152 (6.8%) patients on inhaled corticosteroids and 2098 (93%) controls. Simple and multiple linear regression methods showed a non-significant effect of inhaled steroids on BMD with slight decrease of BMD -0.010 g/cm2(95% CI -0.042 to 0.022, P = .55) and -0.013 g/cm2(95% CI -0.062 to 0.036, P = .61) respectively. Age, gender, body mass index, and smoking were stronger predictors of BMD.


CONCLUSIONS
No statistically significant relationship was detected between the use of inhaled corticosteroids and reduced bone mineral density in this observational study of a cohort of older Australians.
John Hunter Hospital, New Lambton, New South Wales, 2305, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, 2308, Australia.
Ghulam
G
Sarwar
Hunter Research Medical Institute, New Lambton, New South Wales, 2305, Australia.
Alessandra
A
Bisquera
School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, 2308, Australia.|Hunter Research Medical Institute, New Lambton, New South Wales, 2305, Australia.
Roseanne
R
Peel
School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, 2308, Australia.|Hunter Research Medical Institute, New Lambton, New South Wales, 2305, Australia.
Stephen
S
Hancock
John Hunter Hospital, New Lambton, New South Wales, 2305, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, 2308, Australia.|Hunter Research Medical Institute, New Lambton, New South Wales, 2305, Australia.
Christopher
C
Grainge
John Hunter Hospital, New Lambton, New South Wales, 2305, Australia.|School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, 2308, Australia.|Hunter Research Medical Institute, New Lambton, New South Wales, 2305, Australia.
John
J
Attia
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015519:Bone Density / Q000187:drug effects*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D057187:Independent Living; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018608:Ultrasonography, Doppler / Q000379:methods
D000305:Adrenal Cortex Hormones
COPD; asthma; bone mineral density; calcaneal ultrasound; inhaled corticosteroids; osteoporosis