Oct. 20, 2000 -- Inhaled steroids have revolutionized the treatment of severe asthma, but a new study says they, along with oral steroids, may come with an unexpected side effect: osteopenia, or thinning of the bones that can lead to fractures and other bone problems.
Steroids are the cornerstone of asthma management because they cool down the lung inflammation that is the first stage in asthma. The downside of steroids is that they may cause growth suppression in children when used over long periods.
Joseph D. Spahn, MD, and colleagues report in this month's Journal of Allergy and Clinical Immunology that adding inhaled steroids to oral steroids did not increase growth suppression in their study of more than 150 severely asthmatic children, as had been feared. In fact, compared to past studies, growth suppression has improved since the introduction of inhaled steroids, apparently due to better control of the underlying asthma.
But Spahn tells WebMD that 42% of girls and 18% of boys being treated with steroids for severe asthma at his hospital had osteopenia, and almost none of these patients had been given calcium supplements. Spahn is staff physician in the department of pediatrics at National Jewish Medical and Research Center and associate professor of pediatrics at the University of Colorado Health Science Center in Denver.
In fact, about 10% of the children in the study had spine compression fractures, spine irregularities, or decreased height attributable to their thinning bones. Spahn thinks the fact that few of the children were on calcium supplements is a sign that few pediatricians recognized this risk associated with asthma treatment.
David A. Schaeffer, MD, tells WebMD, "I think it is reasonable for children on high-dose inhaled steroids and on long-term [daily or every other day] oral steroids to be given calcium and vitamin D supplementation. I don't think physicians pay enough attention to recommending multivitamin and calcium supplements for high-risk children." Schaeffer is chief of pulmonology/allergy and immunology at the Nemours Children's Clinic in Jacksonville, Fla., and is a member of the American Academy of Pediatrics section on pediatric pulmonology.
The researchers found that the children treated with long-term steroids also had higher rates of high blood pressure, cataracts, and problems related to suppression of adrenal gland activity. Cataracts were present in 14% of the children, and those with cataracts also were most likely to have delayed growth.
Spahn tells WebMD that children who regularly use steroids to control asthma, who do have low calcium intake, and who don't get regular exercise are the most at risk for bone problems. "These kids are often grossly out of shape," Spahn says. "They learn early that exertion can trigger an asthma attack, and they protect themselves by avoiding exercise." He recommends routine supplementation with 1,000 mg of calcium per day plus a multivitamin containing vitamin D, and a regular program of weight-bearing exercise to protect bone health.
Children who also are taking oral steroids for asthma should have yearly eye examinations for cataracts, Spahn says.