Long-term influence of inhaled corticosteroids on bone metabolism and density - Are biological markers predictors of bone loss?

Long-term effects of high doses of inhaled corticosteroids (ICS) on bone de nsity and metabolism are still uncertain. Fifty-one patients (37 male, 14 f emale) using beclomethasone or budesonide at a daily dose > 800 mu g/d (hig h-dose group [Group HD] mean: 983 mu g/d [prescribed dose x estimated compl iance]) or no or < 500 mu g/d (control group [Group C] mean: 309 mu g/d) fo r more than 5 yr were enrolled in this study. Each had, 3 yr ago and at thi s: last evaluation, a clinical evaluation and measurements of expiratory fl ows and of bone density and bone metabolism markers. Lumbar spine bone dens ity (last visit) was similar in the two groups with respective values of 0. 94 +/- 0.03 (HD) and 0.96 +/- 0.83 g/cm(2) (C) (p < 0.05), T and Z scores w ere -1.21 +/- 0.19 and -0.70 +/- 0.18 (HD), -0.95 +/- 0.25 and -0.47 +/- 0. 21 (C) respectively (p > 0.05). A correlation was found between the decreas e in bone density and the mean daily dose of corticosteroid in Group HD alt hough these changes were quite small, mean bone density being unchanged ove r the 3-yr period. Serum and urinary parameters were similar in the two gro ups. Furthermore, neither initial bone density nor any of the biological pa rameters could predict changes in bone density over a period of 3 yr. In co nclusion, bone density was similar in both study groups and not significant ly different over a 3-yr period. Neither initial bone density nor biologica l markers of bone metabolism helped to predict changes In bone mass.