Because asthma is an inflammation of the airways in the lungs, most patients are prescribed anti-inflammatory medications. Oral corticosteroids, such as prednisone, are the most potent anti-inflammatory drugs used to treat asthma. They have a number of known side effects, one of which is bone loss that results in osteoporosis. This type of osteoporosis is known as steroid-induced osteoporosis, or glucocorticoid-induced osteoporosis.
Inhaled corticosteroids are highly effective anti-inflammatory agents that are significantly safer than those administered orally, because less of the drug in its active form is absorbed into the body. Nonetheless, higher doses of inhaled corticosteroid may still cause side effects, including osteoporosis. Therefore, your allergist will always use the lowest effective dose of oral corticosteroid, if it is required, and prescribe inhaled — rather than oral — medication whenever possible, again using the lowest dose that will control asthma symptoms.
If you need daily prednisone or a similar drug to control your asthma, your doctor may want to determine your bone density. Bone mineral density tests are recommended starting at age 65; if you use corticosteroids to control your asthma, you may need earlier monitoring. Your doctor will determine the frequency of bone mineral density monitoring. The test is similar to an X-ray, though with much less radiation.
Who gets osteoporosis?
An estimated 10 million people older than 50 have osteoporosis, and almost 34 million people have low bone mass that puts them at a higher risk for getting the disease. Older people, especially women who have reached menopause, are most at risk. Other factors that increase the risk of osteoporosis are:
- Family history
- Race (non-Hispanic Caucasians and Asians are at higher risk than African-Americans)
- Inadequate calcium and vitamin D intake
- Lack of physical activity
- Cigarette smoking
- Low body weight
- Gender (more common in women)
- Excessive use of alcohol
- Taking oral cortisonelike medications (glucocorticoids) or taking relatively high doses of inhaled corticosteroids
- Taking anti-seizure medications
- Estrogen deficiency in women; low testosterone levels in men
The most common sites for broken bones are the small bones of the back (vertebrae), wrists, upper arms, pelvis and hips. Patients who break one bone are at an increased risk for additional fractures. Broken bones can result in pain, loss of movement and the possible need for surgery.