NHLBI supported study finds inhaled steroids accelerate bone loss in women with asthma -- treatment still recommended for persist...( Premenopausal women who use inhaled co...)

Premenopausal women who use inhaled corticosteroids to treat persistent asthma may experience accelerated bone loss in the hip compared to those who do not use inhaled steroids, according to results of a new study of 109 women ages18 to 45 years old.

In the September 27, 2001, issue of the New England Journal of Medicine (NEJM), researchers at Brigham and Women's Hospital (BWH) in Boston report that the effect of the inhaled steroids was directly related to the dose -- that is, the bone density loss increased with the number of puffs per day and persisted throughout the three-year study.

Although the yearly changes were small, the scientists suggest that the long-term cumulative effect could ultimately put some women at high risk of hip fracture. The study was supported by the National Heart, Lung, and Blood Institute (NHLBI) and the National Center for Research Resources-both components of the National Institutes of Health.

Inhaled steroids are the recommended treatment for persistent asthma, according to NHLBI's 1997 Guidelines for the Diagnosis and Management of Asthma, because they reduce the airways' inflammation and sensitivity to certain irritants and allergens that contribute to asthma symptoms.

"As with all treatments, the goal is to maximize the benefits and minimize the risks," says NHLBI Director Dr. Claude Lenfant. "It is important to recognize that poor asthma control can lead to complications. Research has found repeatedly that compared to other medical therapies, inhaled steroids provide the best daily control of persistent asthma."

Measuring bone density at baseline, six months, and annually thereafter, the researchers compared the results among women who used inhaled triamcinolone acetonide, a steroid, at two dosage levels (4 to 8 puffs per day versus more than 8 puffs per day) and those who did not use inhaled steroids.

They found that those using the inhaled steroids had decreased bone density in
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NIH/National Heart, Lung, and Blood Institute
26-Sep-2001