Inhaled steroids are absorbed into the circulation, but the extent to which they have adverse effects on bone is uncertain. The question is important since 3% of the population takes an inhaled steroid regularly and may do so for many years. The researchers studied the dose-response relation between cumulative inhaled steroid dose and bone-mineral density of nearly adults (119 women) with asthma aged 20-40 years. The average duration of inhaled steroid treatment was 6 years. The authors found a negative association between cumulative dose of inhaled steroid and bone-mineral density at the lumbar spine and hip. This study provides evidence of a negative relation between total cumulative dose of inhaled steroid and bone-mineral density in patients with asthma.
Lancet 2000; 355: 1399-403
Correspondence to: Dr Conroy A Wong
Inhaled steroids for asthma, such as Flovent, Azmacort, and many others must be used with great caution. They are rarely the best long-term option. However, they can be useful in keeping severe asthmatics alive while they are in the process of identifying what the causal factors of the asthma are. In addition to decreasing bone density they also contribute to cataracts, stunted growth in children through impairment of the adrenal, pituitary, hypothalamic axis and an increased risk of diabetes.