EFFECTS OF INHALED CORTICOSTEROIDS ON BONE

Inhaled corticosteroids (ICS) are the most effective therapy for asthm a currently available. The increasing use of ICS raises the issue of p ossible adverse systemic effects. Since one of the most important side -effects of oral corticosteroids (OCS) is osteoporosis, this article f ocuses on current knowledge of the effects of ICS on bone. Generally, doses higher than 1.0 mg/day cause a dose-dependent decrease in serum osteocalcin levels. Decreases in bone density have been suggested afte r treatment with ICS, but in most studies it is impossible to quantify the contribution of previous treatment with OCS and other confounding factors to bone loss. The clinical relevance of the observed changes in the long term is unknown. To date, no fracture data have been repor ted in patients. Beclomethasone dipropionate, budesonide and fluticaso ne propionate do not appear to be different per milligram ICS. In gene ral, the lowest clinically efficacious dosage of ICS should be aimed a t.