OSTEOPOROSIS IN THE CORTICOSTEROID-TREATED PATIENT WITH ASTHMA

Osteoporosis affects 40% of white women older than 45 years of age and 15% of white men older than 50 years of age, resulting in approximate ly 1.5 million annual fractures in the United States. Systemic cortico steroid therapy increases the probability of osteoporosis, even with a lternate-day dosing and with dosages sufficiently low so as not to aff ect the hypothalamic-pituitary-adrenal axis. Inhaled corticosteroid th erapy may affect bone density if high-dose therapy is given to select individuals. The potential of increasing osteoporosis with inhaled cor ticosteroid asthma therapy is a concern because of the availability of more potent inhaled corticosteroid agents and recommendations that in haled corticosteroid therapy be initiated earlier in the course of ast hma, This article provides suggestions, on the basis of the medical li terature and consensus of the authors when specific information was no t available, for assessing and treating osteoporosis in subjects with asthma, Suggested risk categories are ''low risk'' (inhaled corticoste roid dosage of less than or equal to 800 mu g of beclomethasone diprop ionate [BDP]/day in adults or less than or equal to 400 mu g BDP or eq uivalent in children), ''moderate risk'' (inhaled BDP >800 mu g/day in adults or >400 mu g/day in children), and ''high risk'' (systemic cor ticosteroid therapy 4 times a year or daily or alternate-day systemic corticosteroid therapy). Dosage of nasal corticosteroid probably shoul d be added to the orally inhaled corticosteroid for total burden of in haled corticosteroid. Potential treatment strategies based on risk fac tors and bone density if indicated are offered to assist physicians tr eating patients with asthma.