Prevent Bone Loss if Taking Inhaled Steroids

Woman using asthma inhaler
Bone Loss from Inhaled Steroids. Tom Merton / Getty Images

Asthma is a Major Problem Requiring Inhaled Corticosteroids

Asthma is a common chronic lung disease affecting millions of people in the United States. Symptoms of asthma include coughing, wheezing, shortness of breath and chest tightness. Most people with asthma have underlying inflammation in the lungs caused by allergic triggers such as pollen, pet dander, mold and dust mite. This inflammation can lead to worsening symptoms of asthma, and therefore requires treatment with controller therapies.

Inhaled Corticosteroids May Cause Bone Thinning

Controller therapies for asthma include medications such as Singulair (montelukast) and inhaled corticosteroids, which treat inflammation and reduce asthma symptoms. While inhaled corticosteroids are the preferred treatment for asthma, certain side effects occur with inhaled corticosteroids, including thinning of the bones in adults. Thinning of the bones can lead to osteoporosis, and therefore adults using inhaled corticosteroids for long periods should take calcium and vitamin D supplements. Older adults, and those taking high doses of inhaled corticosteroids, should undergo regular screening for bone mineral density using DEXA (dual energy x-ray absorption) scans. 

Given the concern for side effects from inhaled corticosteroids, many people with asthma choose to either not use inhaled corticosteroids, or choose to take less effective medications such as Singulair.

For this reason, many studies have been performed on the effects of inhaled corticosteroids on the effects of bone mineral density. A recent study sought to determine the effects of newer inhaled corticosteroids (which may have fewer side effects on the body) on bone mineral density, and compared them with Singulair, an oral medication that has no known effect on bone mineral density.

Recent Study on Inhaled Corticosteroids and Bone Thinning

A recent study published in 2013 by researchers in Argentina, Denmark and New Jersey sought to determine the effects of inhaled Asmanex and Flovent on the bone mineral density of adult men and women with asthma. Older adults (men older than 50 years of age and women greater than 40 years of age) were not included, along with people with certain medical conditions (including significant vitamin D deficiency), to avoid people having other reasons to have low bone mineral density.  Study subjects were randomized to take either Asmanex low to medium dose, Flovent medium dose, or Singulair every day for 1 year. All subjects took a calcium and vitamin D supplement once daily (calcium 500 mg and vitamin D 400 IU) for one year.

Subjects were followed frequently for asthma control, and DEXA scans at baseline, 6 months and 1 year after taking the medications. During the entire course of the study, asthma symptoms improved for all of the subjects taking the medications.

However, there was no significant loss of bone mineral density in any of the treatment groups. The subjects taking the inhaled corticosteroids, either Asmanex or Flovent, showed no signs of lower bone mineral density on DEXA scans compared to subjects taking Singulair.

The authors of the study concluded that there was no evidence for loss of bone mineral density during short-term use (1 year) of low-to-medium dose inhaled corticosteroids (Asmanex and Flovent) compared to Singulair. This is important because many past studies have shown loss of bone mineral density, typically within the first year, with certain inhaled corticosteroids, although studies of longer duration (2 years) have also shown loss of bone mineral density.

Bottom Line: Taking Calcium and Vitamin D Supplements May Prevent Bone Loss From Inhaled Corticosteroids

This particular study also focused on the effects of inhaled corticosteroids in younger people, because older people, particularly post-menopausal women, are more likely to have thinning bones from other medical causes. This study also chose to supplement subjects with appropriate amounts of calcium and vitamin D in an attempt to prevent loss of bone mineral density. Therefore, this study is reassuring that low-to-medium dose Asmanex and Flovent do not appear to decrease bone mineral density in young-to-middle age adults who are taking calcium and vitamin D supplementation. 

Source:

Maspero J, et al. Effects of Mometasone, Fluticasone, and Montelukast on Bone Mineral Density in Adults with Asthma. J Allergy Clin Immunol Pract. 2013; 649-55.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition. 

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