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Asthma Health Center

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Asthma Drugs Boost Hip Fracture Risk

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


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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