New research, published online in the journal Thorax, has found that taking steroid inhalers or pills for asthma is associated with an increased risk of osteoporosis (brittle bones) and fragility fractures.

The study findings indicate that the risk seems to greater when a person takes higher doses of steroids for a longer period.

Worldwide, asthma affects more than 330 million people. And doctors often advise steroid inhalers and pills to reduce airway inflammation and to prevent or treat asthma symptoms.

Steroid inhalers are prescribed to control moderate to severe asthma and steroid tablets for flare-ups of severe asthma, according to international guidelines.

The study researchers looked at health records of more than 15 million patients from 738 doctors’ surgeries across the United Kingdom. They examined the data to identify all asthmatic patients from April 2004 to December 2017, who also had either osteoporosis or fragility fractures.

The investigators also looked for patients who received at least one dose of bisphosphonates (drugs used to treat or prevent osteoporosis), vitamin D, and calcium supplements.

A detailed analysis of all the data showed a clear link between both a high cumulative dose and the duration of the course of steroids inhaler or tablets and the risk of osteoporosis and fractures.

The researchers found that the patients who received 11 or more prescriptions for steroid inhalers were at a 60% increased risk of having osteoporosis and a 31% risk of having fragility fractures.

However, the researchers pointed out, “Current guidelines on asthma do not fully cover the management of bone comorbidities and no specific bone protection guidance is given. Our results suggest that the risk and prevention of osteoporosis and [fragility fractures] should be addressed explicitly in future guideline updates.”

Since the study was an observational one, it could not establish the cause and the effect. They explained that sometimes people find it difficult to use inhalers correctly, underestimating the actual dose taken.

Nevertheless, the researchers concluded, “Both [inhaled and oral] steroids are associated with an increased risk of osteoporosis and [fragility fracture] in people with asthma. The use of [these drugs] should be kept to the minimum necessary to treat symptoms and should be stepped down if symptoms and exacerbations are well managed.” The authors advised clinicians to consider additional bisphosphonate therapy, vitamin D, and calcium supplements to protect a patient’s bone health who is on steroid inhaler or tablets.