Effects of inhaled glucocorticoids on bone density in premenopausal women.

被引:212
作者
Israel, E
Banerjee, TR
Fitzmaurice, GM
Kotlov, TV
LaHive, K
LeBoff, MS
机构
[1] Brigham & Womens Hosp, Div Pulm & Crit Care Med, Dept Med, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Div Endocrine Hypertens, Skeletal Hlth & Osteoporosis Program, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[5] Harvard Univ, Sch Publ Hlth, Dept Environm Hlth, Boston, MA 02115 USA
[6] Harvard Pilgrim Hlth Care, Dept Internal Med, Boston, MA USA
关键词
D O I
10.1056/NEJMoa002304
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Inhaled glucocorticoids are the most commonly used medications for the long-term treatment of patients with asthma. Whether long-term therapy with inhaled glucocorticoids reduces bone mass, as oral glucocorticoid therapy does, is controversial. In a three-year prospective study, we examined the relation between the dose of inhaled glucocorticoids and the rate of bone loss in premenopausal women with asthma. Methods: We studied 109 premenopausal women, 18 to 45 years of age, who had asthma and no known conditions that cause bone loss and who were treated with inhaled triamcinolone acetonide (100 mu-g per puff). We measured bone density by dual-photon absorptiometry at base line, at six months, and at one, two, and three years. Serum osteocalcin and parathyroid hormone and urinary N-telopeptide, cortisol, and calcium excretion were measured serially. We measured inhaled glucocorticoid use by means of monthly diaries, supported by the use of an automated actuator-monitoring device. Results: Inhaled glucocorticoid therapy was associated with a dose-related decline in bone density at both the total hip and the trochanter of 0.00044 g per square centimeter per puff per year of treatment (P=0.01 and P=0.005, respectively). No dose-related effect was noted at the femoral neck or the spine. Even after the exclusion of all women who received oral or parenteral glucocorticoids at any time during the study, there was still an association between the decline in bone density and the number of puffs per year of use. Serum and urinary markers of bone turnover or adrenal function did not predict the degree of bone loss. Conclusions: Inhaled glucocorticoids lead to a dose-related loss of bone at the hip in premenopausal women. (N Engl J Med 2001;345:941-7.) Copyright (C) 2001 Massachusetts Medical Society.
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页码:941 / 947
页数:7
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