BONE-MINERAL DENSITY IN ASTHMATIC-PATIENTS TREATED WITH INHALED CORTICOSTEROIDS - A CASE-CONTROL STUDY

Recent studies suggest that inhaled corticosteroids can adversely affe ct bone metabolism, The objective of this study was to evaluate the im portance of these adverse effects in a case-control study. Bone minera l density (BMD) was measured in 48 asthmatic adults (15 males and 33 f emales) treated with inhaled steroids (beclomethasone or budesonide) a nd in 48 gender and age-matched healthy subjects at baseline and at 2 yrs. Vertebral EMD was measured by dual energy X-ray densitometry. Pat ients had been treated with a dose of 662+/-278 mu g (range 300-1,000 mu g) of beclomethasone dipropionate or budesonide for more than 1 yr (mean duration of treatment 10.6 yrs, range 1-16 yrs), Twenty four pat ients had needed 1-6 short courses of oral steroids and seven had rece ived oral corticosteroids (mean daily dose 6.2 mg prednisone) for 2-15 yrs more than 4 yrs prior to the BMD measurements. During the follow- up, 14 patients required 1-3 short courses of oral steroids, There was no correlation either between inhaled corticosteroid doses or duratio n of treatment and BMD values, There were no significant differences i n BMD baseline values between patients and healthy controls, BMD signi ficantly decreased in both groups at 2 yrs, from 1.08+/-0.19 to 1.05+/ -0.19 g.cm(-2) (p=0.002) in asthmatics versus 1.12+/-0.17 to 1.09+/-0. 18 g.cm(-2) (p=0.008) in controls. There were no significant differenc es in BMD loss between patients and healthy controls, Furthermore, no differences were found in bone Loss when pre-and postmenopausal women were compared with their healthy control counterparts, No differences in baseline BMD acre found between patients who had received regular o ral corticosteroid therapy or boaster courses of oral corticosteroids and those who had not. Inhaled corticosteroid treatment at a mean dose of 662 mu g.day(-1) and sporadic booster courses of oral corticostero ids do not further increase bone mass loss with respect to that expect ed from natural bone mass loss.