Effect of Inhaled Corticosteroids on Bone Mineral Density in Childhood Asthma: Comparison of Fluticasone Propionate with Beclomethasone Dipropionate

There is a dearth of data on long-term effects of inhaled corticosteroids (ICS) on bone architecture in childhood asthma. This study was designed to assess the possible effects of two different inhaled steroids on bone mineral density (BMD) in steroid-native, prepubertal children. Twenty-three children were randomized to receive equipotent doses of either fluticasone propionate (100 mg twice daily) or beclomethasone dipropionate (200 mg twice daily). They were followed up over a period of 20 months with regular dual-energy X-ray absorptiometry scans for BMD. Densitometry of lumbar spine and total body showed a significant increase over time, which followed the normal patterns for growth. No difference was observed between the two subgroups. There was no change in fat distribution over time and no increase in percentage total body fat. As expected, girls had significantly higher total body fat. This absence of deleterious effects suggests that in the standard doses used neither beclomethasone nor fluticasone has any significant effect on bone density over a moderate period of time. Further studies should continue monitoring BMD through the critical years of bone mass accumulation during adolescence.