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Asthma and Osteoporosis Risk

Asthma and Osteoporosis Risk

Learn about the association between asthma and osteoporosis, a disease that causes thinning of the bones.

Are you one of the approximately 26 million people in the U.S. with asthma? If you are, you should know that you may also be at higher risk of osteoporosis, a disease that causes the bones to become thinner and weaker and is responsible for millions of bone fractures each year.

Why are asthma patients more likely to develop osteoporosis? Prescription anti-inflammatory corticosteroids are the main culprit, says Karen Calhoun, MD, a professor of otolaryngology—head and neck surgery.

Anti-inflammatory corticosteroids are either inhaled or taken orally, generally twice a day, to help control symptoms and prevent attacks. They are not used as a fast-relief medicine to treat acute asthma attacks.

"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 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.

While oral corticosteroids are very effective at keeping inflammation—and thus asthma symptoms such as wheezing and difficulty breathing—at bay, these 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.

If you must take oral anti-inflammatory corticosteroids, what can you do to prevent osteoporosis?

Up your calcium and vitamin D intake
Calhoun recommends consuming adequate amounts of calcium and vitamin D each day to counteract the bone-thinning effects of corticosteroids. Your healthcare provider may recommend supplements 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. Vitamin D is found naturally in only a handful of foods, including fatty fish like mackerel, tuna and salmon. Although it's often added to milk and orange juice, you may need to take supplement to ensure that your dietary needs are met. Always check with your healthcare provider before taking a supplement and to discuss appropriate dosages.

Keep your lifestyle healthy
There is a known association 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. You should also avoid alcohol, as alcohol can interfere with the absorption of nutrients and affect your bones.

Exercise is also important. 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, bodyweight movements 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 density, 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).

Get a bone scan
Get a baseline DEXA (dual energy x-ray absorptiometry) bone-density scan. This test will likely be covered by insurance, but check with your insurance provider beforehand. This is particularly important for 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 and 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, in which case you will need another scan in six months.

Consider different asthma therapies
If you're currently taking oral corticosteroids, ask your doctor about other 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; and allergy shots if you have allergic asthma.

Medically reviewed in May 2018.

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