Steroid Inhalers for Asthma Can Weaken Bones
April 21, 2000 -- A steroid inhaler may be your best friend if you have
asthma. It's easy to use and generally has fewer side effects than steroid
pills. But a new study shows that high doses of inhaled steroids for asthma may
in fact lead to weak and thinning bones -- a side effect that, until now, was
primarily associated with steroid pills.
The study also suggests that the more asthma patients used inhaled steroids,
the weaker their bones became.
Inhaled steroids are frequently used to decrease inflammation and airway
blockage and are one of the main treatments used for asthma. Doctors and
patients generally prefer them to steroid pills because steroid pills have more
side effects -- one of the most troubling being bone loss that can lead to
However, physicians and researchers were not sure if enough inhaled steroids
got into the bloodstream to cause bone loss. So this study looked at people who
had been on inhaled steroids for asthma for about six years and tested their
bone density, a sign of bone strength.
This study points out that another risk of using inhaled steroids for asthma
may indeed be bone loss, according to Norman H. Edelman, MD, who was not
involved in the study. He says that doctors and patients have to weigh the
risks of asthma against osteoporosis when making a decision about treatment
with inhaled steroids. Edelman is the dean of the School of Medicine at the
State University of New York at Stony Brook and a scientific consultant to the
American Lung Association.
The researchers found that the patients with asthma taking high doses of
inhaled steroids had a significant loss in bone density. The three inhaled
steroids used in the study were Beclovent, Flovent, and Pulmicort. Other
steroid inhalers used in the U.S. that were not included in the study are
Aerobid and Azmacort. These results are published in the April 22 issue of the
medical journal The Lancet.
You should tell your doctor about this new study, Edelman says. "Ask
your physician what you can do to protect your bones. Also ask what they are
doing to ensure that your risk of bone density loss is as low as
"The key question is, how do you get the benefit of inhaled steroids
with the least amount of risk?" says Thomas Plaut, MD, who reviewed the
study for WebMD. "Not everybody needs them. Someone who does a good job of
cleaning up their environment and eliminating allergens such as dust, pollen,
and animal dander can cut their need for inhaled steroids by up to
He says people with mild asthma -- about 60% of all asthma patients -- can
often get relief by using instead a medication that doesn't contain steroids to
relieve inflammation, such as Accolate, Singulair, or Tilade. However, for many
patients, particularly those with moderate or severe asthma, that will not be
sufficient. Plaut is the author of Dr. Tom Plaut's Asthma Guide. He is
in private practice in Amherst, Mass., and acts as a consultant on asthma
issues to health plans and state and municipal health departments.