Impact of long-term inhaled corticosteroid therapy on bone mineral density

Results of a meta-analysis

Michael Halpern, Jordana K. Schmier, Maria D. Van Kerkhove, Michael Watkins, Chris J. Kalberg

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: The impact of long-term inhaled corticosteroid (ICS) therapy on bone mineral density (BMD) is poorly understood. Objective: To evaluate the impact of long-term ICS use on BMD. Methods: Random-effects meta-analysis. Published and unpublished literature were identified by searches of MEDLINE and EMBASE databases and consultation with experts. Studies reporting BMD among adult asthma and chronic obstructive pulmonary disease (COPD) patients using ICS and non-ICS controls were identified. Studies selected for review included at least 1 year of follow-up. Two independent reviewers evaluated studies; data from those meeting specified inclusion criteria were abstracted for inclusion in the meta-analysis. Results: Fourteen (5.3%) of 266 reviewed studies met specified inclusion criteria. Sufficient data were available to perform meta-analysis on 3 measures for ICS-using patients (lumbar, femoral neck, and major trochanter BMD) and 1 measure (lumbar BMD) for non-ICS-using controls. Using current National Asthma Education and Prevention Program definitions, the majority of studies (12 of 14) included patients receiving moderate to high doses of ICSs. Among ICS users, annual changes from baseline in lumbar, femoral neck, and major trochanter BMD (-0.23%, -0.17%, and +1.46%, respectively) were not statistically significant. Mean changes in lumbar BMD were also not significantly different from controls (-0.02%). Further, annual changes in lumbar BMD were not statistically significant for subgroups of patients with asthma or COPD. Conclusions: Long-term use of ICSs in patients with asthma or COPD was not associated with significant changes in BMD.

Original languageEnglish (US)
Pages (from-to)201-207+267
JournalAnnals of Allergy, Asthma and Immunology
Volume92
Issue number2
StatePublished - Feb 2004
Externally publishedYes

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Bone Density
Meta-Analysis
Adrenal Cortex Hormones
Asthma
Chronic Obstructive Pulmonary Disease
Therapeutics
Femur Neck
Femur
MEDLINE
Referral and Consultation
Databases
Education

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Impact of long-term inhaled corticosteroid therapy on bone mineral density : Results of a meta-analysis. / Halpern, Michael; Schmier, Jordana K.; Van Kerkhove, Maria D.; Watkins, Michael; Kalberg, Chris J.

In: Annals of Allergy, Asthma and Immunology, Vol. 92, No. 2, 02.2004, p. 201-207+267.

Research output: Contribution to journalArticle

Halpern, M, Schmier, JK, Van Kerkhove, MD, Watkins, M & Kalberg, CJ 2004, 'Impact of long-term inhaled corticosteroid therapy on bone mineral density: Results of a meta-analysis', Annals of Allergy, Asthma and Immunology, vol. 92, no. 2, pp. 201-207+267.
Halpern, Michael ; Schmier, Jordana K. ; Van Kerkhove, Maria D. ; Watkins, Michael ; Kalberg, Chris J. / Impact of long-term inhaled corticosteroid therapy on bone mineral density : Results of a meta-analysis. In: Annals of Allergy, Asthma and Immunology. 2004 ; Vol. 92, No. 2. pp. 201-207+267.
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