Corticosteroids are a common asthma treatment, but are they also bad for your bones? Find out what the experts think.
If you take corticosteroids as part of your asthma treatment plan, they likely play an important role in helping you manage your asthma symptoms. But some studies also link this type of drug, commonly available in the form of an asthma inhaler, to bone loss and osteoporosis.
Dozens of studies starting in the late1990s and continuing into the early 2000s have tied corticosteroid to osteoporosis. When corticosteroids are administered for a long time, and in high doses, the side effect of osteoporosis is a common problem. This has been shown both in asthma patients, in addition to patients taking corticosteroids for other reasons.
What the Experts Say About Corticosteroids and Osteoporosis
While the issue of osteoporosis may be a concern for patients with severe asthma who have to take high doses of corticosteroids, the average asthma patient who just has to use an asthma inhaler shouldn’t have to worry too much about it, says Ronald M. Ferdman, MD, an assistant professor of pediatrics at the University of Southern California.
“At typical doses, we don’t see any problems,” says Dr. Ferdman. “Of course, there are people who for reasons unknown are exquisitely sensitive to even low-dose steroids who may have some bone effect, but these instances are rare. If a patient is on high-dose inhaled steroids for a long period of time (years), it is not unreasonable to check for the development of osteoporosis, but it is not routinely done because the effect is so rare and so minimal.”
Indeed, it seems that osteoporosis is a very rare side effect of all types of inhaled steroids through an asthma inhaler, which is the most common use of these drugs as an asthma treatment. However, the side effect of osteoporosis is much more common when taking oral corticosteroids in pill form. This form of corticosteroid is seldom used for asthma, and only in severe cases.
“Oral steroids can be given as a ‘burst’ (usually around five days) to treat an asthma attack,” says Ferdman. “Very rarely, patients with the most severe asthma must take an oral steroid daily for months or years at a time to control their asthma. In these patients that must take oral steroids daily, osteoporosis is a very real risk, and they should be monitored for it and treated if needed. For patients who need short oral ‘bursts,’ we usually don’t monitor for osteoporosis unless they require very frequent and ongoing bursts,” he says.
Corticosteroids and Osteoporosis: What You Can Do About It
As mentioned above, frequent monitoring of the bones of patients on daily oral corticosteroids is critical in preventing future problems with osteoporosis. Your doctor may do this through a bone density screening. Your doctor may also want to check your testosterone level (for males) or estrogen level (for females) to make sure that you don’t have a deficiency.
If you have to take oral steroids daily, your doctor may also prescribe calcium and vitamin D supplements, which have been shown to help with some of the bone loss associated with long-term oral corticosteroid use. Hormone-replacement therapy has also been used in older women to fight off some of the effects of osteroporosis.
When it comes to the inhaled steroids used to treat asthma, however, our experts reiterate that the side effects of bone loss are rare, and the benefits of the corticosteroids far outweigh the risks. “Corticosteroids are very valuable in treating asthma. They help decrease inflammation in the lungs, so the small airways or bronchials stay open,” says Nick Peters, MD, vice president of Medical Operations for Concentra. “Now that physicians can offer this valuable medicine by an inhaler, the side effects are nearly eliminated. Short-term use of steroids has minimal side effects.”
If you take corticosteroids as part of your asthma treatment plan, they likely play an important role in helping you manage your asthma symptoms. But some studies also link this type of drug, commonly available in the form of an asthma inhaler, to bone loss and osteoporosis.
Dozens of studies starting in the late1990s and continuing into the early 2000s have tied corticosteroid to osteoporosis. When corticosteroids are administered for a long time, and in high doses, the side effect of osteoporosis is a common problem. This has been shown both in asthma patients, in addition to patients taking corticosteroids for other reasons.
What the Experts Say About Corticosteroids and Osteoporosis
While the issue of osteoporosis may be a concern for patients with severe asthma who have to take high doses of corticosteroids, the average asthma patient who just has to use an asthma inhaler shouldn’t have to worry too much about it, says Ronald M. Ferdman, MD, an assistant professor of pediatrics at the University of Southern California.
“At typical doses, we don’t see any problems,” says Dr. Ferdman. “Of course, there are people who for reasons unknown are exquisitely sensitive to even low-dose steroids who may have some bone effect, but these instances are rare. If a patient is on high-dose inhaled steroids for a long period of time (years), it is not unreasonable to check for the development of osteoporosis, but it is not routinely done because the effect is so rare and so minimal.”
Indeed, it seems that osteoporosis is a very rare side effect of all types of inhaled steroids through an asthma inhaler, which is the most common use of these drugs as an asthma treatment. However, the side effect of osteoporosis is much more common when taking oral corticosteroids in pill form. This form of corticosteroid is seldom used for asthma, and only in severe cases.
“Oral steroids can be given as a ‘burst’ (usually around five days) to treat an asthma attack,” says Ferdman. “Very rarely, patients with the most severe asthma must take an oral steroid daily for months or years at a time to control their asthma. In these patients that must take oral steroids daily, osteoporosis is a very real risk, and they should be monitored for it and treated if needed. For patients who need short oral ‘bursts,’ we usually don’t monitor for osteoporosis unless they require very frequent and ongoing bursts,” he says.
Corticosteroids and Osteoporosis: What You Can Do About It
As mentioned above, frequent monitoring of the bones of patients on daily oral corticosteroids is critical in preventing future problems with osteoporosis. Your doctor may do this through a bone density screening. Your doctor may also want to check your testosterone level (for males) or estrogen level (for females) to make sure that you don’t have a deficiency.
If you have to take oral steroids daily, your doctor may also prescribe calcium and vitamin D supplements, which have been shown to help with some of the bone loss associated with long-term oral corticosteroid use. Hormone-replacement therapy has also been used in older women to fight off some of the effects of osteroporosis.
When it comes to the inhaled steroids used to treat asthma, however, our experts reiterate that the side effects of bone loss are rare, and the benefits of the corticosteroids far outweigh the risks. “Corticosteroids are very valuable in treating asthma. They help decrease inflammation in the lungs, so the small airways or bronchials stay open,” says Nick Peters, MD, vice president of Medical Operations for Concentra. “Now that physicians can offer this valuable medicine by an inhaler, the side effects are nearly eliminated. Short-term use of steroids has minimal side effects.”
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