Steroids Accelerate Bone Loss in Women with Asthma

A three-year study has found that premenopausal women who use inhaled corticosteroids to treat persistent asthma may experience bone loss in the hip. The bone density loss increased with the number of puffs per day and persisted throughout the study. Conducted by researchers at Brigham and Women's Hospital (Boston, MA, USA), the study was published in the September 27, 2001, issue of The New England Journal of Medicine.

The study involved 109 women 18-45 years old who used an inhaled steroid, triamcinolone acetonide, to treat asthma. The researchers found that the treatment decreased bone density in the hip but not in the spine or femoral neck of the women. The rates of bone density varied among the women, but the effects were greater with higher dosages and longer duration of use. Although the yearly changes were small, the researchers suggest that the long-term cumulative effect could ultimately put some women at high risk of hip fracture.

One option to lower steroid dosage is to supplement therapy with long-acting beta-agonists. Two recent studies found that adult men and women with mild-to-moderate persistent asthma who used both medications were able to reduce steroid dosage an average of 50% without losing symptom control. However, those treated with beta-agonists alone suffered from significantly worse symptoms compared to those treated with inhaled steroids alone or with both medications.

"We encourage all patients with asthma to work with their doctors on a comprehensive treatment plan; that is, the lowest possible dose of inhaled steroids that controls their asthma symptoms as well as measures to maintain good bone health, such as adequate calcium and vitamin D intake,” said Dr. Claude Lenfant, director of the U.S. National Heart, Lung, and Blood Institute, which helped fund the study.




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