Effects of inhaled glucocorticoids on bone density in premenopausal women.

Background: Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term ther apy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we exami ned the relation between the dose of inhaled glucocorticoids and the rate o f bone loss in premenopausal women with asthma. Methods: We studied 109 premenopausal women, 18 to 45 years of age, who had asthma and no known conditions that cause bone loss and who were treated w ith inhaled triamcinolone acetonide (100 mu-g per puff). We measured bone d ensity by dual-photon absorptiometry at base line, at six months, and at on e, two, and three years. Serum osteocalcin and parathyroid hormone and urin ary N-telopeptide, cortisol, and calcium excretion were measured serially. We measured inhaled glucocorticoid use by means of monthly diaries, support ed by the use of an automated actuator-monitoring device. Results: Inhaled glucocorticoid therapy was associated with a dose-related decline in bone density at both the total hip and the trochanter of 0.00044 g per square centimeter per puff per year of treatment (P=0.01 and P=0.005 , respectively). No dose-related effect was noted at the femoral neck or th e spine. Even after the exclusion of all women who received oral or parente ral glucocorticoids at any time during the study, there was still an associ ation between the decline in bone density and the number of puffs per year of use. Serum and urinary markers of bone turnover or adrenal function did not predict the degree of bone loss. Conclusions: Inhaled glucocorticoids lead to a dose-related loss of bone at the hip in premenopausal women. (N Engl J Med 2001;345:941-7.) Copyright ( C) 2001 Massachusetts Medical Society.