Asthma Drugs Boost Hip Fracture Risk

[Guest guest]

webmd.com/content/article/56/65804.htm?

 

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.