Men's Osteoporosis Support Group
Inhaled corticosteroids and bone density; vitamin D and bone turnover markers
Tunis Med. 2011 May;89(5):434-9. Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: A 20 cases study. Hamida KS and others. PMID: 21557179. This study looked at the effect of inhaled corticosteroids used for 12 or more months on bone mineral density (BMD) in adults aged from 20 to 45 years. The average daily dose was 925 g [Editor's note: I believe this figure should be in mcg, not g] of equivalent of beclometasone for an average of 33.5 months. They used bone density tests to compare the active corticosteroid users to age- and sex-matched controls. They found no statistically significant effect from the corticosteroid on spine of hip BMD and they concluded, “Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density.” [Emphasis mine].
Editor's comments. Multiple studies have shown that high dose oral corticosteroids cause loss of BMD. Here's an Update showing that even when individuals took high-dose vitamin D or 10 mg alendronate (Fosamax) along with the corticosteroids, only the alendronate was protective of BMD. Here's a Newsletter citing the safety of several forms of inhaled corticosteroids. So the Hamida study confirms the results of several others regarding the safety of inhaled corticosteroids and their effect on BMD. There appears to be no need to take a bisphosphonate or extra-strength vitamin D to prevent bone loss. Just remember these results don't apply to high dose oral corticosteroids. They definitely reduce BMD and require the use of preventive FDA-approved osteoporosis medication concomitantly.
Endocr Pract. 2011 May 6:1-21. [Epub ahead of print]. The Effect of Vitamin D Therapy on Bone Turnover Markers in Postmenopausal Women with Osteoporosis and Osteopenia. Tanzy ME, Camacho PM. PMID: 21550960. This study on women with low BMD, and who either had normal or low serum vitamin D levels, compared the effect of vitamin D supplements to alendronate regarding the bone turnover marker bone specific alkaline phosphatase (BSAP). The women who received vitamin D all had deficient serum vitamin D levels, while all receiving alendronate had sufficient serum vitamin D.
The results showed no significant difference in the reduction of BSAP after one year of therapy. The authors concluded, “The results of this study suggest that correction of vitamin D deficiency in osteopenia and osteoporosis patients can lead to a decrease in bone turnover as measured by BSAP and that the magnitude of this reduction is similar to that achieved with oral bisphosphonates.”
Editor's comments. So this study found equal results when measuring BSAP (a marker of bone breakdown) in individuals with low BMD. The question is if BSAP would be a proxy for low BMD, and if reducing BSAP would also show increased BMD via dual-energy X-ray absorptiometry (DXA) testing.
This study involved only women, but vitamin D and alendronate are not gender-specific medications—so equal results would be expected with men. The results are suggestive that in individuals with low BMD, and who have low serum vitamin D levels, that vitamin D supplementation possibly could be the sole initial therapy needed. If later BMD testing shows no improvement, or additional loss of BMD after bringing serum vitamin D levels into the normal range, that would indicate the need of an FDA-approved osteoporosis medication. You might want to discuss this option with your care provider if you have both low serum vitamin D and low BMD.