Effect of inhaled steroids on bone mineral density: A meta-analysis

Inhaled corticosteroids are currently considered first-line agents for the treatment of asthma. Medium- to long-term administration of inhaled steroids may be associated with bone loss. Various studies have evaluated their effect on bone mineral density (BMD); some have shown loss of BMD with steroid treatment, but others have failed to do so. The present meta-analysis was undertaken to determine the possible effect of inhaled steroids on bone density. Literature was collected using computerized (MEDLINE) and manual searches using index medicus and checking cross-references of the published articles. The studies identified were screened for inclusion/exclusion criteria. Grouped means (X-T/X-C) and pooled standard deviations (SDT/SDC) for the treatment group (X-T [95% CI] = 1.144 [1.019-1.269]; SDT = 0.163, g/cm(2)) and control group (X-C [95% CI] = 1.193 [1.073-1.313]; SDC = 0.157, g/cm(2)) were worked out respectively for the selected studies, Finally, a comparison between grouped means of steroid-treated and control groups was done by two-sample test at the 5% level of significance. The results of the metaanalysis showed that although the mean BMD of the steroid-treated group was reduced by 4.1% as compared to the control group, this failed to achieve statistical significance (p = 0.8; 95% CI for the mean difference between two groups = 0.028 - 0.070 g/cm(2)). It is concluded that inhaled steroids for the treatment of asthma can be considered safe with respect to their effect on bone loss. (C)2003 the American College of Clinical Pharmacology.