A randomized, double-blind study comparing the effects of beclomethasone and fluticasone on bone density over two years

Cross-sectional studies have suggested that asthmatic patients receiving high dose inhaled corticosteroids and intermittent courses of oral corticosteroids have reduced bone mass. This prospective 2-yr study was undertaken to evaluate changes in bone density of patients receiving high doses of inhaled corticosteroids. Patients (n = 33) (males aged 18-50 yrs, females aged 18-40 yrs) on inhaled corticosteroids 1,000-2,000 microg x day(-1), were randomized in a double-blind fashion to either fluticasone propionate (FP) 1,000 microg x day(-1) or beclomethasone dipropionate (BDP) 2,000 microg x day(-1). In parallel, three open control groups of the same age range were studied: asthmatics (n = 8) receiving low dose inhaled corticosteroids (< or =400 microg x day(-1)) (group A); chronic, severe asthmatics (n = 8) receiving oral corticosteroids (> or =10 mg x day(-1) (group B); and healthy untreated volunteers (n = 7) (group C). Bone densitometry scans (quantitative computed tomography (QCT) of spine; dual X-ray absorptiometry of spine, femoral neck, and single photon absorptiometry of forearm) were performed at baseline and after 6, 12 and 24 months of treatment. Biochemical bone marker measurements (serum osteocalcin, bone alkaline phosphatase, pro-collagen type 1 carboxy terminal propeptide, deoxypyridinoline and C-telopeptide of type 1 collagen) were collected every 3 months. Fifteen FP (mean age 36 yrs, six male) and 9 BDP patients (mean age 33 yrs, five male); completed the study. At 0 months, mean bone mineral density (BMD) was lower in patients receiving inhaled corticosteroids (both low dose and high dose) than in normal volunteers. In the FP-treated group, mean vertebral trabecular BMD quantitative computed tomography remained stable with no evidence of decline, whereas there was some decline in the BDP-treated group. The treatment difference between FP and BDP was statistically significant in favour of FP for quantitative computed tomography measurements after 12 months (p = 0.006) and 24 months (p = 0.004). This study suggests that over 24 months, changes in bone density are minimal in patients on high-dose inhaled corticosteroids.

This article has been cited by other articles:

				I A Campbell, J G Douglas, R M Francis, R J Prescott, and D M Reid Five year study of etidronate and/or calcium as prevention and treatment for osteoporosis and fractures in patients with asthma receiving long term oral and/or inhaled glucocorticoids Thorax, September 1, 2004; 59(9): 761 - 768. [Abstract] [Full Text] [PDF]

				E. Weir COPD death rates: projecting a female trajectory Can. Med. Assoc. J., February 3, 2004; 170(3): 334 - 334. [Full Text] [PDF]

				A.A. Ionescu and E. Schoon Osteoporosis in chronic obstructive pulmonary disease Eur. Respir. J., November 2, 2003; 22(46_suppl): 64s - 75s. [Abstract] [Full Text] [PDF]

				O. Johnell, R. Pauwels, C-G. Lofdahl, L.A. Laitinen, D.S. Postma, N.B. Pride, and S.V. Ohlsson Bone mineral density in patients with chronic obstructive pulmonary disease treated with budesonide Turbuhaler(R) Eur. Respir. J., June 1, 2002; 19(6): 1058 - 1063. [Abstract] [Full Text] [PDF]

				D. M. Biskobing COPD and Osteoporosis Chest, February 1, 2002; 121(2): 609 - 620. [Abstract] [Full Text] [PDF]

				E. Israel, T. R. Banerjee, G. M. Fitzmaurice, T. V. Kotlov, K. LaHive, and M. S. LeBoff Effects of Inhaled Glucocorticoids on Bone Density in Premenopausal Women N. Engl. J. Med., September 27, 2001; 345(13): 941 - 947. [Abstract] [Full Text] [PDF]

				A E Tattersfield, G I Town, O Johnell, C Picado, M Aubier, P Braillon, and R Karlström Bone mineral density in subjects with mild asthma randomised to treatment with inhaled corticosteroids or non-corticosteroid treatment for two years Thorax, April 1, 2001; 56(4): 272 - 278. [Abstract] [Full Text]

				The use of inhaled corticosteroids in adults with asthma DTB, January 1, 2000; 38(1): 5 - 8. [Abstract] [Full Text] [PDF]