Why Asthma Patients Are More Likely To Develop Osteoporosis
Reviewed by QualityHealth's Medical Advisory Board
Are you one of the approximately 25 million people in the U.S. with asthma? If you are, you should know that in addition to having to deal with the symptoms associated with this chronic disease, you may also be at higher risk of osteoporosis, or thinning bones. Osteoporosis affects roughly 10 million people over 50 in the U.S., and a further 34 million people are in danger of developing the potentially painful and disabling condition.
Why are asthma patients more likely to develop osteoporosis? Prescription anti-inflammatory corticosteroids (generic names include flunisolide, fluticasone propionate, hydrocortisone, and prednisone) are the main culprit, says Karen Calhoun, MD, a professor in the department of otolaryngology—head and neck surgery—at the Wexner School of Medicine at Ohio State University in Columbus.
Anti-inflammatory corticosteroids are either inhaled or taken orally, generally twice a day, to help control symptoms and prevent attacks. (They are not used to treat acute asthma attacks.) While anti-inflammatory corticosteroids are very effective at keeping inflammation—and thus asthma symptoms such as wheezing and difficulty breathing—at bay, these long-acting "control" medications may also cause the loss of bone density, or bone thickness. Over time, if bones become brittle enough, a person may suffer back pain due to compression fractures of the vertebrae (the bones that form the backbone) and loss of height, and may easily sustain fractures. These are all signs that osteoporosis has set in.
While medication may be a necessary evil for someone with asthma, the good news is that not every asthma patient is on the road to osteoporosis. "For the most part, the patients who are on inhaled corticosteroids are not at huge risk," says Calhoun. On the other hand, asthma patients who take oral corticosteroids, or “the big guns,” as she puts it, do run more of a risk, as oral corticosteroids are more effectively absorbed into the body and are usually prescribed at a higher dose than inhaled versions. Oral corticosteroids are prescribed when a person's asthma is not well controlled by other, less potent medications.
If you must take anti-inflammatory corticosteroids, what can you do to try to prevent osteoporosis?
- Up your calcium and vitamin D intake. Calhoun recommends consuming at least one gram (1,000 mg) of calcium and 1,000 international units (IU) of vitamin D a day to counteract the bone-thinning effects of corticosteroids. Your doctor may recommend even higher doses based on your personal situation. For calcium, food is your best source, so concentrate on getting plenty of dairy products along with leafy greens and fortified cereals, and take a supplement if necessary. Vitamin D is found naturally in only a small handful of foods, including fatty fish like mackerel, tuna, and salmon. Although it's often added to milk and orange juice, experts suggest taking a supplement to ensure that your dietary needs are met.
- Don't smoke. Studies have shown a direct link between cigarette smoking and higher rates of osteoporosis. It's unclear, however, whether cigarettes themselves cause bones to weaken or whether behaviors and attributes common to smokers are the cause.
- Don't drink too much alcohol. Alcohol can interfere with the absorption of nutrients and affect your bones.
- Exercise. Bones that are challenged are healthier bones. And while any exercise is good, weight-bearing exercise—exercise that puts stress on your bones—is key. "That is incredibly important," Calhoun says. "You can actually increase your bone density." Walking, running, tennis, and dancing all are examples of weight-bearing exercise. Strength training, in which you challenge your muscles to grow stronger using barbells, weight machines, or bands, is crucial, too. Unfortunately, swimming, a popular activity for people with asthma, is not a weight-bearing exercise and will not do much for bone health, however beneficial it may be for the cardiovascular system. Finally, you should also work on improving your balance to minimize your risk of falling (which can lead to fractures). Tai chi may be a good way to do this.
- Get a baseline DEXA (dual energy x-ray absorptiometry) bone-density scan.This is particularly important if you're a post-menopausal woman. Knowing if you already have osteoporosis, or if you're close to developing it, can help guide your asthma treatment choices. If the scan reveals you have low bone density, you will probably be asked to repeat it within one or two years of starting a bone-building regimen, such as taking vitamin D or engaging in weight-bearing exercise. If you have normal bone density, you may be allowed to go five to seven years before the next scan, unless you are taking high-dose oral steroids.
- Consider new asthma therapies. If you're currently taking oral corticosteroids, ask your doctor your options. Available treatments include monoclonal antibody therapy (in which a substance combines with a specific protein in the body to block the inflammatory reaction); inhaled long-acting bronchodilators, which control asthma symptoms and prevent attacks by keeping the airways open for 12 hours; allergy shots, or even thermal bronchoplasty, which involves the delivery of radiofrequency energy via endoscopy.
Karen Calhoun, MD, reviewed this article.
Karen Calhoun, MD, Wexner School of Medicine, Ohio State University, Columbus. Phone conversation with source on December 23, 2014.
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"Calcium and Vitamin D: What You Need to Know." National Osteoporosis Foundation. Page accessed February 3, 2015.
"Treating Asthma With Bronchodilators." Cleveland Clinic. Page last reviewed on April 14, 2011.
Updated: February 18, 2015