Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1986 Dec 6;293(6560):1463–1466. doi: 10.1136/bmj.293.6560.1463

Corticosteroids and bone mass in asthma: comparisons with rheumatoid arthritis and polymyalgia rheumatica.

D M Reid, J J Nicoll, M A Smith, B Higgins, P Tothill, G Nuki
PMCID: PMC1342237  PMID: 3099913

Abstract

Bone mass has previously been shown to be reduced at peripheral bone sites in patients with bronchial asthma receiving corticosteroids. To assess whether total bone mass is reduced in asthma total body calcium was measured by in vivo neutron activation analysis in patients receiving various treatments for asthma and compared with results from normal controls and patients with rheumatoid arthritis and polymyalgia rheumatica. Compared with controls total body calcium was reduced by 13.6% (p less than 0.001) in patients with asthma receiving daily oral corticosteroids but by only 9.0% (p less than 0.005) in a similar group of patients who had received oral calcium supplements at the start of their corticosteroid treatment. Total body calcium was also reduced in a group of patients receiving only inhaled corticosteroids (8.8%; p less than 0.001) but not significantly reduced in a small group of patients with asthma who had never received these drugs. When compared with controls a group of patients matched for age and for dose of corticosteroids given for rheumatoid arthritis had a similar reduction in total body calcium to the patients with asthma receiving daily oral treatment (17.7%; p less than 0.001), but no such reduction was shown in patients with polymyalgia rheumatica. These findings suggest that the risk of bone loss with low dose oral corticosteroids in similar in asthma and rheumatoid arthritis. Further work is required to assess the clinical relevance of small losses of bone associated with the use of inhaled corticosteroids.

Full text

PDF
1463

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adinoff A. D., Hollister J. R. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. doi: 10.1056/NEJM198308043090502. [DOI] [PubMed] [Google Scholar]
  2. Baylink D. J. Glucocorticoid-induced osteoporosis. N Engl J Med. 1983 Aug 4;309(5):306–308. doi: 10.1056/NEJM198308043090509. [DOI] [PubMed] [Google Scholar]
  3. Cohn S. H., Ellis K. J., Wallach S., Zanzi I., Atkins H. L., Aloia J. F. Absolute and relative deficit in total-skeletal calcium and radial bone mineral in osteoporosis. J Nucl Med. 1974 Jun;15(6):428–435. [PubMed] [Google Scholar]
  4. Deding A., Tougaard L., Krogh Jensen M., Rodbro P. Bone changes during prednisone treatment. Acta Med Scand. 1977;202(4):253–255. doi: 10.1111/j.0954-6820.1977.tb16822.x. [DOI] [PubMed] [Google Scholar]
  5. Dykman T. R., Haralson K. M., Gluck O. S., Murphy W. A., Teitelbaum S. L., Hahn T. J., Hahn B. H. Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum. 1984 Dec;27(12):1336–1343. doi: 10.1002/art.1780271203. [DOI] [PubMed] [Google Scholar]
  6. Eastell R., Kennedy N. S., Smith M. A., Simpson J. D., Strong J. A., Tothill P. The assessment of postmenopausal osteoporosis by total body neutron activation analysis. Metab Bone Dis Relat Res. 1983;5(2):65–67. doi: 10.1016/0221-8747(83)90003-6. [DOI] [PubMed] [Google Scholar]
  7. Gaddie J., Petrie G. R., Reid I. W., Skinner C., Sinclair D. J., Palmer K. N. Aerosol beclomethasone dipropionate: a dose-response study in chronic bronchial asthma. Lancet. 1973 Aug 11;2(7824):280–281. doi: 10.1016/s0140-6736(73)90788-5. [DOI] [PubMed] [Google Scholar]
  8. Gluck O. S., Murphy W. A., Hahn T. J., Hahn B. Bone loss in adults receiving alternate day glucocorticoid therapy. A comparison with daily therapy. Arthritis Rheum. 1981 Jul;24(7):892–898. doi: 10.1002/art.1780240705. [DOI] [PubMed] [Google Scholar]
  9. Hahn T. J., Boisseau V. C., Avioli L. V. Effect of chronic corticosteroid administration on diaphyseal and metaphyseal bone mass. J Clin Endocrinol Metab. 1974 Aug;39(2):274–282. doi: 10.1210/jcem-39-2-274. [DOI] [PubMed] [Google Scholar]
  10. Hahn T. J., Halstead L. R., Baran D. T. Effects off short term glucocorticoid administration on intestinal calcium absorption and circulating vitamin D metabolite concentrations in man. J Clin Endocrinol Metab. 1981 Jan;52(1):111–115. doi: 10.1210/jcem-52-1-111. [DOI] [PubMed] [Google Scholar]
  11. Hahn T. J., Halstead L. R., Teitelbaum S. L., Hahn B. H. Altered mineral metabolism in glucocorticoid-induced osteopenia. Effect of 25-hydroxyvitamin D administration. J Clin Invest. 1979 Aug;64(2):655–665. doi: 10.1172/JCI109506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johansson S. A., Andersson K. E., Brattsand R., Gruvstad E., Hedner P. Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. Eur J Respir Dis Suppl. 1982;122:74–82. [PubMed] [Google Scholar]
  13. Kennedy N. S., Eastell R., Ferrington C. M., Simpson J. D., Smith M. A., Strong J. A., Tothill P. Total body neutron activation analysis of calcium: calibration and normalisation. Phys Med Biol. 1982 May;27(5):697–707. doi: 10.1088/0031-9155/27/5/004. [DOI] [PubMed] [Google Scholar]
  14. Löfdahl C. G., Mellstrand T., Svedmyr N. Glucocorticoids and asthma. Studies of resistance and systemic effects of glucocorticoids. Eur J Respir Dis Suppl. 1984;136:69–79. [PubMed] [Google Scholar]
  15. MURRAY R. O. Radiological bone changes in Cushing's syndrome and steroid therapy. Br J Radiol. 1960 Jan;33:1–19. doi: 10.1259/0007-1285-33-385-1. [DOI] [PubMed] [Google Scholar]
  16. Matzer L., Cortada X., Ferrer P., De Armendi F., Kinney E. L. Widened E point septal separation in a normal pediatric population. Chest. 1985 Jan;87(1):73–75. doi: 10.1378/chest.87.1.73. [DOI] [PubMed] [Google Scholar]
  17. Mazess R. B., Peppler W. W., Chesnut C. H., 3rd, Nelp W. B., Cohn S. H., Zanzi I. Total body bone mineral and lean body mass by dual-photon absorptiometry. II. Comparison with total body calcium by neutron activation analysis. Calcif Tissue Int. 1981;33(4):361–363. doi: 10.1007/BF02409456. [DOI] [PubMed] [Google Scholar]
  18. Ott S. M., Murano R., Lewellen T. K., Nelp W. B., Chesnut C. M., 3rd Total body calcium by neutron activation analysis in normals and osteoporotic populations: a discriminator of significant bone mass loss. J Lab Clin Med. 1983 Oct;102(4):637–645. [PubMed] [Google Scholar]
  19. Reid D. M., Kennedy N. S., Smith M. A., Nicoll J., Brown N., Tothill P., Nuki G. Bone loss in rheumatoid arthritis and primary generalized osteoarthrosis: effects of corticosteroids, suppressive antirheumatic drugs and calcium supplements. Br J Rheumatol. 1986 Aug;25(3):253–259. doi: 10.1093/rheumatology/25.3.253. [DOI] [PubMed] [Google Scholar]
  20. Reid D. M., Kennedy N. S., Smith M. A., Tothill P., Nuki G. Total body calcium in rheumatoid arthritis: effects of disease activity and corticosteroid treatment. Br Med J (Clin Res Ed) 1982 Jul 31;285(6338):330–332. doi: 10.1136/bmj.285.6338.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Rüegsegger P., Medici T. C., Anliker M. Corticosteroid-induced bone loss. A longitudinal study of alternate day therapy in patients with bronchial asthma using quantitative computed tomography. Eur J Clin Pharmacol. 1983;25(5):615–620. doi: 10.1007/BF00542348. [DOI] [PubMed] [Google Scholar]
  22. Toogood J. H., Lefcoe N. M., Haines D. S., Chuang L., Jennings B., Errington N., Baksh L., Cauchi M. Minimum dose requirements of steroid-dependent asthmatic patients for aerosol beclomethasone and oral prednisone. J Allergy Clin Immunol. 1978 Jun;61(6):355–364. doi: 10.1016/0091-6749(78)90114-8. [DOI] [PubMed] [Google Scholar]
  23. Tse C. S., Bernstein I. L. Corticosteroid aerosols in the treatment of asthma. Pharmacotherapy. 1984 Nov-Dec;4(6):334–342. doi: 10.1002/j.1875-9114.1984.tb03397.x. [DOI] [PubMed] [Google Scholar]
  24. Wyatt R., Waschek J., Weinberger M., Sherman B. Effects of inhaled beclomethasone dipropionate and alternate-day prednisone on pituitary-adrenal function in children with chronic asthma. N Engl J Med. 1978 Dec 21;299(25):1387–1392. doi: 10.1056/NEJM197812212992504. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES