Limitations of these studies
These studies, though, have limitations. The follow-up periods for all of these studies are less than 5 years, and thus the longer-term effects of prolonged use of inhaled corticosteroids on BMD or fracture risk cannot be determined with this evidence. Furthermore, the study populations were relatively young, with few other risk factors (they were, for example, predominantly male) than populations at highest risk for osteoporosis and fracture. These factors limit interpretation of the data for long-term inhaled corticosteroids use, particularly in populations with higher baseline osteoporosis risk—older persons with chronic lung disease who take inhaled corticosteroids for more than 2 to 3 years. We need better and longer-term studies to help advise our patients about the risks and benefits of inhaled corticosteroids therapy.
Recommendations from others
The New Zealand Guideline Group says the risk of reduced BMD increased with long-term, high-dose inhaled corticosteroids.6 The Institute for Clinical Systems Improvement guidelines recommends considering osteoporosis prevention measures for those who have been (or will be) taking a daily high-dose inhaled glucocorticoid for several years as glucocorticoid use compounds fracture risk beyond that determined solely by BMD.7