[Inhaled steroids effect on bones].

Abstract

Inhaled corticosteroids (ICS) are the mainstay of asthma treatment, when an antiinflammatory agent is warranted. The development of the ICS has permitted to diminish the adverse effects associated with oral steroids and with equipotent doses there are less adverse effects with ICS on bone metabolism compared to oral steroids. There is now reassuring evidence that doses of < or = 400 micrograms for children and < or = 1000 micrograms for adults are safe and do not appear to have clinically significant adverse effect on bone density or bone growth. When exceeding the recommended thresholds for more than 3 months, osteoporosis prevention would be appropriate. Furthermore a mineral bone density measurement might be done in this context in order to identify those persons who are at risk of developing or worsening preexisting osteoporosis. Growth monitoring is justified in any child taking ICS. Biochemical markers of bone formation and resorption might give complementary information to the mineral bone density measurement. The addition of a leukotriene receptor antagonist and or of a chromone may allow a reduction in the requirement for ICS in mild to moderate asthma. Finally the achievement of an increased glucocorticoid potency combined with an improved airway selectivity and a shorter plasmatic half-life of the ICS will further contribute to diminish their effects on bone metabolism.