As previous studies have shown oral steroids to accelerate bone loss, researchers at Brigham and Women’s Hospital in Boston set out to determine whether inhaled steroids (in this study, triamcinolone acetonide) can also produce this effect.

By monitoring drug use and changes in bone density in 109 premenopausal asthmatic women, they found that the more puffs per day, the greater the change per year in bone density of the whole hip and femur. The bone loss was significant and translated to a more than twofold greater risk of hip fracture than that seen among healthy women aged 65 years or older.

Physicians need to work harder to find the minimum dose required to provide asthma control, and make sure that patients maintain adequate dietary calcium and vitamin D intake, say the researchers. In addition, patients who must stay on high doses should be monitored regularly (N Engl J Med, 2001; 345: 941-7).