Asthma Drugs Boost Hip Fracture Risk

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Asthma Drugs Boost Hip Fracture Risk

 

Evidence Growing That Inhaled Steroids, Like Pills, Can Cause Bone Loss

 

 

 

By Sid Kirchheimer

WebMD Medical News Reviewed By Brunilda Nazario, MD

on Thursday, December 12, 2002

 

Dec. 12, 2002 -- Like their pill-form counterparts, evidence is mounting that

inhaled corticosteroids, among the most effective drug treatments for persistent

asthma, can raise the risk of bone fractures. And the higher the dose, the

greater the risk.

 

 

 

In the latest published report, British researchers found a slight but steady

risk of hip fractures among elderly women who took inhaled steroids such as

Azmacort and Flovent. Their study examined the use of various types of

corticosteroids by more than 16,000 elderly people who had hip fractures

compared with 30,000 others without fractures.

 

 

 

" Our data suggests that in older patients, there is a small dose-related

association between the recent use of inhaled corticosteroid and the risk of hip

fracture, " they write in the December 2002 issue of the American Journal of

Respiratory and Critical Care Medicine. The researchers found that the risk of

hip fracture associated with the use of inhaled corticosteriods was increased by

almost 30%.

 

 

 

Since the 1950s, long-term use of oral corticosteroids -- prescribed for asthma,

rheumatoid arthritis, bowel disease, and other conditions -- has been linked

with a significant increase in the risk of osteoporosis, which can result in hip

and other bone fractures. That's because these drugs act like cortisol, a

naturally produced hormone that helps regulate blood sugar and metabolism, but

also accelerates bone loss by preventing calcium absorption in the gut, and

increasing calcium loss through urine. These drugs can also cause damage to the

cells that help build bone. Some studies indicate that bone fractures occur in

up to half the patients who use oral corticoids for longer than three

consecutive months.

 

 

 

But evidence continues to accumulate linking accelerated bone loss resulting

from the use of inhaled steroids as well, which decrease inflammation and

swelling in the airways and boost the effect of bronchodilator medications.

Although prescribed in lower doses than oral steroids, inhalers today deliver

more corticosteroids per puff and have higher potency than those previously

available.

 

 

 

The British researchers, like previous investigators, found hip fracture risk

increased steadily with increasing duration of use. They also found the same

relationship of a steady increase in the risk of fracture with increasing

dosages.

 

 

 

Stavros C. Manolagas, MD, PhD, director of the Center for Osteoporosis and

Metabolic Bone Disease at the University of Arkansas, says he not surprised by

the findings. He says oral steroids have higher concentrations of

cortisol-acting properties, but inhaled steroids are often used for longer than

three months, a period that has been implicated with higher fracture risk.

 

 

 

" If you expect to take inhaled corticosteroids for longer than three months, my

advice is that you talk to your doctor about also prescribing a bisphosphonate

such as Fosamax, which is used to treat osteoporosis, " he tells WebMD.

 

 

 

More advice for asthmatics using these drugs: Speak to your doctor about putting

you on the lowest possible dose to treat your condition.

 

 

 

The British researchers only examined elderly female patients, who are prone to

hip fracture since osteoporosis risk increases following menopause and estrogen

loss -- whether or not corticosteroids are used. However, this age group is also

being diagnosed with asthma in record numbers. In both the U.S and the U.K.,

roughly one in 10 seniors are already known to have asthma or chronic lung

disease. The American Lung Association reports some 25 million Americans have

been diagnosed with asthma, including more than 2 million who are older than age

65.

 

 

 

But it's not just the elderly who face increased fracture risk from inhaled

steroids. A study in the New England Journal of Medicine last year found that

women between ages 18 and 45 who used inhaled corticosteroids to treat

persistent asthma had accelerated hip bone loss and that these losses increased

with the number of puffs per day. In fact, the researchers calculated that a

30-year-old woman taking six puffs of Azmacort twice daily would have the same

bone loss at age 50 as a 65-year-old who didn't use inhaled steroids.

 

 

 

SOURCES: American Journal of Respiratory and Critical Care Medicine, December

2002 • New England Journal of Medicine, Sept. 27, 2001 • Journal of Bone and

Mineral Research, March 2001 • Journal of Bone and Mineral Research, June 2000 •

American Lung Association• Stavros C. Manolagas, MD, PhD, director, Center for

Osteoporosis and Metabolic Bone Disease; and director of Endocrinology and

Metabolism at the University of Arkansas College of Medicine.

 

 

 

 

 

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