The Asthma Center

Corticosteroids and osteoporosis

Corticosteroids are known to be among the most effective medications for the treatment of asthma. However, corticosteroid use in high doses and/or over long periods of time is also a known risk factor for osteoporosis. Therefore when corticosteroids are needed, it is imperative to use the lowest possible dose in order to minimize the risk of osteoporosis.

Osteoporosis, or loss of mineralization of skeletal bone, is a very common disease process that affects millions of Americans. Osteoporosis is thought to cause more than a million fractures a year, often involving the spine. Osteoporosis often develops in middle aged and older individuals. In particular, it commonly affects postmenopausal women. Under normal circumstances, bones are hard and do not fracture easily. Mineral deposits (e.g. calcium) laid down in bones give rigidity and strength to the skeleton. Osteoporosis occurs when not enough calcium has been laid down or may be due to increased reabsorption of calcium from the bones. The risk of osteoporosis is increased by:

  • Use of some medications (corticosteroids)
  • Hormonal change (menopause, Cushing's disease, hyperthyroidism)
  • Lack of physical activity
  • Genetic disorders
  • Cigarette smoking
  • Alcoholism
  • Liver disease
  • Uncontrolled diabetes
  • Other disorders (e.g. COPD)

Osteoporosis is not usually associated with symptoms until a fracture occurs. Fractures most commonly involve the spine, hip and wrist. Loss of height also commonly occurs with osteoporosis since the weakened spine may become compressed.

Asthma and Osteoporosis
If you have used oral corticosteroids over long periods of time, you are at significant risk for developing osteoporosis since this form of steroid promotes the loss of mineral bone deposits. The higher the dose of corticosteroids and/or the longer the period of use, the greater the risk becomes for you to develop osteoporosis. Fortunately the use of inhaled corticosteroids at recommended doses does not appear to be commonly associated with osteoporosis since the body only absorbs very small amounts of corticosteroids. Nevertheless you should evaluate your bone mineralization status in order to assess the risk of taking inhaled corticosteroids over long periods of time.

Diagnosis and Treatment
Although marked osteoporosis can be identified on a routine x-ray, the best way to diagnose early signs of osteoporosis is with a DXA scan (dual energy x-ray absorptiometry). Early diagnosis can lead to effective treatment that can make a significant long term difference and prevent fractures.

If you have one or more risk factors for osteoporosis and/or are middle-aged or an older adult who has used inhaled corticosteroids (Advair®, Flovent®, Pulmicort®, QVAR®, Azmacort®, etc.) regularly over long periods, you should have a bone densitometry study at appropriate intervals to see if you are at risk for this disease.

Treatment consists of:

  • Prevention through limiting factors that promote bone loss (discontinue smoking and alcohol use)
  • Nutrition (increased calcium and vitamin D)
  • Hormonal replacement (estrogen)
  • Exercise to promote bone mineralization
  • Medical treatment (Fosamax®, Actonel®, calcitonin, etc.)