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Effect of Inhaled Steroids on Bone Mineral Density: A Meta-Analysis

From the Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Dr. Sharma, Dr. Malhotra, Dr. Pandhi) and the Department of Statistics, Panjab University, Chandigarh, India (Dr. Kumar)

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 (SD_T/SD_C) for the treatment group (X_T [95% CI] = 1.144 [1.019-1.269]; SD_T = 0.163, g/cm²) and control group (X_C [95% CI] = 1.193 [1.073-1.313]; SD_C = 0.157, g/cm²) 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 t-test at the 5% level of significance. The results of the meta-analysis 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/cm²). It is concluded that inhaled steroids for the treatment of asthma can be considered safe with respect to their effect on bone loss.

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