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Effects of inhaled glucocorticoids on bone density in premenopausal women.
Open accessAbstract
BACKGROUND: Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term therapy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we examined the relation between the dose of inhaled glucocorticoids and the rate of 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 with inhaled triamcinolone acetonide (100 microg per puff). We measured bone density by dual-photon absorptiometry at base line, at six months, and at one, two, and three years. Serum osteocalcin and parathyroid hormone and urinary N-telopeptide, cortisol, and calcium excretion were measured serially. We measured inhaled glucocorticoid use by means of monthly diaries, supported 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 the spine. Even after the exclusion of all women who received oral or parenteral glucocorticoids at any time during the study, there was still an association 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.
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“The most universally described skeletal consequence of glucocorticoid therapy is a reduction in BMD, which can lead to increased fracture risk (243-245).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [243]
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“the skeletal response to prednisolone in these rats shared several similarities to changes observed in humans, including significantly decreased BMD (243), histological evidence of increased bone resorption (194), and biochemical evidence of suppressed bone formation (244, 267, 268).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [243]
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The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis
Staa, T. P. V., Staa, T. P. V., Staa, T. P. V., Leufkens, H. G. M., & Cooper, C. (2002) · Osteoporosis International · doi:10.1007/s001980200108 · Cited by 1,294
Kearns, A. E., Khosla, S., & Kostenuik, P. J. (2008) · Endocrine Reviews · doi:10.1210/er.2007-0014 · Cited by 824
Significant variability in response to inhaled corticosteroids for persistent asthma
Szefler, S. J., Martin, R. J., King, T. S., Boushey, H. A., Cherniack, R. M., Chinchilli, V. M., Craig, T., DOLOVICH, M. B., Drazen, J. M., Fagan, J. K., et al. (2002) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2002.122635 · Cited by 616
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Metadata
- Authors
- Israel, E., Banerjee, T. R., Fitzmaurice, G. M., Kotlov, T. V., LaHive, K., & LeBoff, M. S.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Harvard Pilgrim Health Care (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2001-09-27
- Volume
- 345
- Issue
- 13
- Pages
- 941-947
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2061819610
- Cited by
- 303
- References
- 25
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 5 · 2021: 7 · 2020: 5 · 2019: 3 · 2018: 10 · 2017: 9 · 2016: 11 · 2015: 12 · 2014: 6 · 2013: 6 · 2012: 8
- FWCI
- 32.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Heart, Lung, and Blood Institute (HL0843)
- National Center for Research Resources (M01 RR 02635, M01RR002635)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- inhaled corticosteroids, bone mineral density, bone loss, asthma, premenopausal women, triamcinolone acetonide, dose-response relationship, hip bone, glucocorticoid-induced osteoporosis, bone turnover markers, osteocalcin, parathyroid hormone, urinary N-telopeptide, adrenal function
- MeSH terms
- Administration, Inhalation, Adolescent, Adult, Asthma, Dose-Response Relationship, Drug, Female, Femur, Glucocorticoids, Humans, Lumbar Vertebrae, Middle Aged, Pelvic Bones, Triamcinolone Acetonide, Cohort Studies, Bone Density, Premenopause
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