Chronic use of the asthma drug corticosteroid may have some serious impact on bones, according to a study presented at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle.
The results came after an analysis of large population databases by researchers led by Dr. Rebecca Green, assistant professor, paediatric endocrinology and diabetes, Washington University School of Medicine in St. Louis.
"For many diseases corticosteroids have been 'miracle drugs,' effectively controlling symptoms where no other medications had succeeded before. However, along with the benefits of high dose corticosteroids, important side effects have emerged," said Green.
Inhaled corticosteroids are one of the most effective medications for controlling asthma. The anti-inflammatory medications reduce swelling in the airways, improve lung function, and act to prevent asthma episodes or "asthma attacks." Intervention with inhaled corticosteroids can improve asthma control and reduce emergency department visits, hospitalisation and deaths.
The side effects linked with the drug include decreased bone mineral density and reduced bone mass, and also in children, reduced growth rate.
Green said that the strategies to lessen these effects include minimizing oral doses and adding topical or inhaled steroids to provide the same anti-inflammatory benefit in the areas affected by inflammation while avoiding systemic effects.
She further added that disturbance in childhood bone acquisition could decrease peak bone mass, thereby triggering lifetime risk of osteoporosis.
"One of the challenges has been distinguishing the effects of the inflammatory process itself on bone mass and growth, and the effects of corticosteroids on bone growth from the effects of corticosteroids on bone mass," she said.
She added: "Analysis of large population databases has recently yielded extremely valuable data about corticosteroids and fractures, with some unexpected impact of lower doses. Analysis of the same database for inhaled steroid use in adults showed a small increase in fracture risk in users of inhaled steroids compared to control, but comparable risk of fracture in inhaled steroid users compared to individuals using inhaled bronchodilators. This suggests that the increased risk of fracture was secondary to the disease itself, not the inhaled steroids."
According to the Childhood Asthma Management Program (CAMP) study, inhaled corticosteroids are safe and effective for the long-term treatment of children with mild to moderate asthma.
In a follow-up CAMP cohort study conducted by H. William Kelly, PharmD, and colleagues, the researchers examined the effects of multiple short courses or oral steroids and long-term inhaled corticosteroids on bone mineral growth over a period of years.
In the study, it was found that neither oral corticosteroid bursts nor inhaled corticosteroids had any hand in 27 fractures in females and 40 in males.