Inhaled Corticosteroids Reduce Bone Mineral Density in Early Postmenopausal but Not Premenopausal Asthmatic Women
K. FUJITA,1 S. KASAYAMA,2 J. HASHIMOTO,3 Y. NAGASAKA,4
N. NAKANO,4 Y. MORIMOTO,5 P.J. BARNES,6 and A. MIYATAKE7
1 University of Shiga Prefecture, Hikone, Shiga, Japan.
2 Department of Medicine III, Osaka University Medical School, Osaka, Japan.
3 Department of Orthopedics, Osaka University Medical School, Osaka, Japan.
4 Department of Pulmonary Medicine, Kinki University Sakai Hospital, Osaka, Japan.
5 Department of Internal Medicine, Aizenbashi Hospital, Osaka, Japan.
6 Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom.
7 Miyatake Asthma Clinic, Osaka, Japan.
Inhaled corticosteroids are widely used in the treatment of bronchial asthma, but it is still uncertain whether long-term use of the inhaled corticosteroids affects bone metabolism in asthmatic patients. In this study, we examined the effect of inhaled beclomethasone dipropionate (BDP) on bone mineral density (BMD) and biochemical markers of bone metabolism in pre- and early postmenopausal asthmatic women. Thirty-six (17 premenopausal and 19 early postmenopausal) asthmatic women and 45 healthy control (24 premenopausal and 21 early postmenopausal) women were investigated. All the asthmatic patients were treated with BDP (542 } 298 Ęg/day; 100-1200 Ęg/day) without any systemic administration of corticosteroids for at least 1 year. In premenopausal women, BMD as well as the biochemical markers of bone metabolism did not differ between control subjects and BDP-treated asthmatic patients. By contrast, in early postmenopausal women, BMD was significantly lower in BDP-treated asthmatic patients than in control subjects. In these early postmenopausal women, serum intact osteocalcin concentration was lower in the BDP-treated asthmatic patients than in the control subjects whereas urinary free pyridinoline (F-PYD) and free deoxypyridinoline (F-DPD) concentrations did not differ between the groups. Thus, early postmenopausal, but not premenopausal, asthmatic patients who were treated with inhaled BDP had reduced BMD, which was associated with a decreased level of the bone formation marker. Ovarian hormones may be protective against the adverse effect of inhaled BDP on bone metabolism in the premenopausal patients. (J Bone Miner Res 2001;16:782-787)
Key words: inhaled corticosteroids; beclomethasone; bronchial asthma; postmenopausal women; osteocalcin
April 2001, Volume 16, Number 4