Do inhaled steroids reduce bone mineral density and increase fracture risk?

Abstract

Inhaled corticosteroids (ICS) at low to medium doses (<1500 mcg beclomethasone hydrofluoroalkane per day) for asthma and chronic obstructive pulmonary disease (COPD) don't increase the risk of significant bone loss or fracture at 2 to 3 years follow-up (strength of recommendation [SOR]: A, systematic reviews and randomize controlled trials [RCTs]). Higher doses, however, may raise the risk of nontraumatic fracture over 1 to 4 years of follow-up (SOR: B, case control studies). Experts recommend using the lowest effective dose to mitigate potential bone risks (SOR: C, expert consensus).