Am. J. Respir. Crit. Care Med., Vol 151, No. 2, 02 1995, 333-336.
Oral and inhaled corticosteroids reduce bone formation as shown by plasma osteocalcin levels
K Meeran, A Hattersley, J Burrin, R Shiner and K Ibbertson
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom.
Osteoporosis is a well-known, serious complication of long-term high- dose
corticosteroid therapy. This study was performed to determine the effects
of commonly used doses of oral and inhaled steroids on biochemical indices
of bone formation. Initially we examined the long- term effects of oral
steroids. Thirty-four outpatients with symptomatic asthma or chronic
obstructive airways disease (COAD) receiving long- term oral prednisolone
(mean 10.1 mg daily) were compared with 34 control subjects with asthma or
COAD matched individually for age, sex, and menopausal status who were not
taking oral steroids. Plasma osteocalcin concentrations were significantly
lower (patients 6.3 +/- 0.1 ng/ml; control subjects 8.6 +/- 0.5 ng/ml, mean
+/- SEM; p < 0.01) in patients on steroids with no difference in
alkaline phosphatase. To examine the short-term effects of oral and inhaled
corticosteroids, healthy male volunteers were given a 7-d course of either
15 mg oral prednisolone daily (n = 10) or 500 micrograms inhaled
beclomethasone twice daily (n = 20). After 1 wk of oral prednisolone, mean
plasma osteocalcin decreased from 11.8 +/- 1.1 ng/ml to 6.9 +/- 0.8 ng/ml
(p < 0.001). With inhaled beclomethasone mean plasma osteocalcin
decreased from 11.6 +/- 0.6 ng/ml to 9.6 +/- 0.6 ng/ml (p < 0.001) with
no change in alkaline phosphatase. In doses routinely prescribed for the
prophylaxis and treatment of asthma, oral and inhaled steroids suppress
osteocalcin levels and may therefore inhibit bone formation. This effect is
seen with short courses of steroids and also with chronic
administration.(ABSTRACT TRUNCATED AT 250 WORDS)
