Inhaled Corticosteroids and Bone Health

Carolyn Chee*, 1, Luckni Sellahewa 2, Joseph M Pappachan 3
1 Department of Endocrinology, Nottingham University Hospitals, NG7 2UH, UK
2 Department of Endocrinology, Royal Derby Hospital, Derby, DE22 3NE, UK
3 Department of Endocrinology, Walsall Manor Hospital, West Midlands, WS2 9PS, UK

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© Chee et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Endocrinology, Nottingham University Hospitals, Nottingham, NG7 2UH, UK; Tel: +44-115 924 9924; Fax: +44-115 9701080; E-mail:


Inhaled corticosteroids (ICS) are the cornerstones in the management of bronchial asthma and some cases of chronic obstructive pulmonary disease. Although ICS are claimed to have low side effect profiles, at high doses they can cause systemic adverse effects including bone diseases such as osteopenia, osteoporosis and osteonecrosis. Corticosteroids have detrimental effects on function and survival of osteoblasts and osteocytes, and with the prolongation of osteoclast survival, induce metabolic bone disease. Glucocorticoid-induced osteoporosis (GIO) can be associated with major complications such as vertebral and neck of femur fractures. The American College of Rheumatology (ACR) published criteria in 2010 for the management of GIO. ACR recommends bisphosphonates along with calcium and vitamin D supplements as the first-line agents for GIO management. ACR recommendations can be applied to manage patients on ICS with a high risk of developing metabolic bone disease. This review outlines the mechanisms and management of ICS-induced bone disease.

Keywords: Bisphosphonate, bone mineral density (BMD), glucocorticoid-induced osteoporosis (GIO), ICS-induced bone disease, inhaled corticosteroids (ICS)..