GP Bootsma, PN Dekhuijzen, J Festen, PG Mulder, LM Swinkels and CL van Herwaarden
Department of Pulmonary Diseases, University Hospital, Nijmegen, the Netherlands.

Inhaled corticosteroids (ICS) in dosages above 1,000 micrograms/d may influence parameters of bone metabolism. Fluticasone propionate (FP) is a new ICS with a higher clinical potency than beclomethasone dipropionate (BDP) combined with negligible oral bioavailability. The aim of this study was to evaluate the effects of FP and BDP in clinically equipotent dosages on indices of bone metabolism and morning cortisol. FP 750 micrograms/d and BDP 1,500 micrograms/d were compared in a randomized, double-blind, crossover study consisting of two 6-wk treatment periods, each preceded by a 3-wk single-blind placebo period. Twenty-one nonsmoking asthmatic completed the study. FP had the same effect on FEV1 and peak expiratory flow as the double dose of BDP. Both treatments did not change morning cortisol. BDP decreased both osteocalcin and procollagen type 1 carboxyterminal propeptide, indices of bone formation, significantly by 18.5 and 21.9%, respectively. In contrast, FP did not change any variable of bone formation. FP and BDP did not increase type 1 collagen carboxyterminal telopeptide and deoxypyridinoline crosslinks, both markers of bone resorption. In changes in parameters of bone metabolism indicate adverse effects on bone quality in the long term, FP may offer an advantage over BDP.

This article has been cited by other articles:

				S. Schuh, P. T. Dick, D. Stephens, M. Hartley, S. Khaikin, L. Rodrigues, and A. L. Coates High-Dose Inhaled Fluticasone Does Not Replace Oral Prednisolone in Children With Mild to Moderate Acute Asthma Pediatrics, August 1, 2006; 118(2): 644 - 650. [Abstract] [Full Text] [PDF]

				F. T. Leone, J. E. Fish, S. J. Szefler, and S. L. West Systematic Review of the Evidence Regarding Potential Complications of Inhaled Corticosteroid Use in Asthma: Collaboration of American College of Chest Physicians, American Academy of Allergy, Asthma, and Immunology, and American College of Allergy, Asthma, and Immunology Chest, December 1, 2003; 124(6): 2329 - 2340. [Abstract] [Full Text] [PDF]

				S. Schuh, J. Reisman, M. Alshehri, A. Dupuis, M. Corey, R. Arseneault, G. Alothman, O. Tennis, and G. Canny A Comparison of Inhaled Fluticasone and Oral Prednisone for Children with Severe Acute Asthma N. Engl. J. Med., September 7, 2000; 343(10): 689 - 694. [Abstract] [Full Text] [PDF]

				T C Medici, E Grebski, M Häcki, P Rüegsegger, C Maden, and J Efthimiou Effect of one year treatment with inhaled fluticasone propionate or beclomethasone dipropionate on bone density and bone metabolism: a randomised parallel group study in adult asthmatic subjects Thorax, May 1, 2000; 55(5): 375 - 382. [Abstract] [Full Text]

				The use of inhaled corticosteroids in adults with asthma DTB, January 1, 2000; 38(1): 5 - 8. [Abstract] [Full Text] [PDF]

				M. F. Goldstein, J. J. Fallon Jr, and R. Harning Chronic Glucocorticoid Therapy-Induced Osteoporosis in Patients With Obstructive Lung Disease* Chest, December 1, 1999; 116(6): 1733 - 1749. [Abstract] [Full Text] [PDF]

				B. J. Lipworth Systemic Adverse Effects of Inhaled Corticosteroid Therapy: A Systematic Review and Meta-analysis Arch Intern Med, May 10, 1999; 159(9): 941 - 955. [Abstract] [Full Text] [PDF]

				L.-P. BOULET, J. MILOT, L. GAGNON, P. E. POUBELLE, and J. BROWN Long-Term Influence of Inhaled Corticosteroids on Bone Metabolism and Density . Are Biological Markers Predictors of Bone Loss? Am. J. Respir. Crit. Care Med., March 1, 1999; 159(3): 838 - 844. [Abstract] [Full Text]

				R. A. PAUWELS, J. C. YERNAULT, M. G. DEMEDTS, and P. GEUSENS Safety and Efficacy of Fluticasone and Beclomethasone in Moderate to Severe Asthma Am. J. Respir. Crit. Care Med., March 1, 1998; 157(3): 827 - 832. [Abstract] [Full Text] [PDF]