Effect of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma: a cross-sectional study

ObjectiveThe objective of this study was to examine the impact of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma.MethodsWe conducted a cross-sectional study in children aged 7-17 years with asthma, who received long-term (>= 2 years), medium to high-dose inhaled budesonide (>= 400 mu g/day in 6-11 years old; >= 800 mu g/day in >11 years old). We measured bone mineral density (BMD) using dual-energy X-ray absorptiometry and compared it with reference Indian normative values.ResultsThirty-five children with moderate to severe asthma receiving long-term medium to high-dose inhaled budesonide, were included in the study. We found a significantly low lumbar-spine BMD in the study population compared to reference Indian values (p-value 0.002). Eight cases had short stature. Despite the adjustment for height-age in these short-stature cases, lumbar-spine BMD remained significantly low in the study population (p-value 0.020). No significant difference was found in 25-hydroxy vitamin D levels between subjects with "low BMD" and "BMD z-score > -2".ConclusionsThe findings of this study suggest that long-term medium to high-dose inhaled budesonide treatment in children with asthma is associated with decreased BMD. However, further investigation with a larger sample size is necessary to confirm this relationship.