Do inhaled steroids increase the risk of osteoporosis?

Abstract

The use of inhaled corticosteroids at conventional doses for asthma and chronic obstructive pulmonary disease (COPD) does not appear to be associated with significant bone loss at 2 to 3 years of follow-up (strength of recommendation [SOR]: A, systematic reviews and randomized controlled trials [RCTs]). However, higher doses of inhaled corticosteroids may be associated with negative bone density changes at up to 4 years of follow-up (SOR: C, RCTs without change in fracture rates). No evidence exists to evaluate whether nasal steroids increase the risks of bone loss. Longer-term effects of prolonged use of inhaled steroids on BMD or fracture risk are undetermined with current evidence.