Use of inhaled corticosteroids and bone mineral density in a population based study: the Nord-Trøndelag Health Study (the HUNT Study)

Arnulf Langhammer, Ensio Norjavaara, Maria Gerhardsson de Verdier, Roar Johnsen, Leif Bjermer
Pharmacoepidemiology and Drug Safety 2004, 13 (8): 569-79
Conflicting results have been reported of the long-term effects of treatment with inhaled corticosteroids (ICS) on bone. The objective of this study was to compare ICS users and non-users regarding bone mineral density (BMD) in a large population. A total of 65,225 adults participated in a cross-sectional study in the Nord-Trøndelag Health Study 1995-1997. Those reporting asthma or asthma-related symptoms, were invited to have bone densitometry of the forearm, flow volume spirometry and a personal interview. Altogether 4482 women and 4142 men participated, of whom 2113 reported ever use and 6511 never use of ICS. Never-users of corticosteroids had a mean BMD, adjusted for confounders (age, square age, sex, body mass index, height, physical activity, work load, packyears, family history of osteoporosis and in women number of years since menopause and use of hormone replacement therapy), of 0.493 g/cm2 at the distal site. Subjects having only used ICS or combined with courses of prednisolone, had 0.008 g/cm2 (95%CI: 0.005-0.011) lower BMD whilst users of prednisolone > or = 6 months had 0.038 g/cm2 (0.021-0.055) lower level. No dose response association between ICS and BMD, or difference in BMD by type of ICS was found. The association between CS use and BMD was independent of the measuring site. ICS use was associated with lower BMD. The lack of dose response in this study might be due to a narrow dose range or indicates that other characteristics of the patient group are contributing to the observed difference in ICS users compared to never-users.

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