Asthma and Bone Health Asthma and Bone Health
The NIH Osteoporosis and Related Bone Diseases National Resource Center

Asthma is a chronic lung disease that affects between 12 and 14 million Americans, more than four million of whom are under the age of 18. Asthma is becoming more common and African Americans are especially at risk. For an asthmatic everyday things can trigger an asthma attack, such as air pollution, allergens, exercise, infections, emotional upset or certain foods.

Typical asthma symptoms include coughing, wheezing, tightness in the chest, difficulty breathing, a rapid heart rate and sweating. Children with asthma often complain of an itchy upper chest or develop a dry cough, which may be the only sign of an asthma.

Asthma itself, does not pose a threat to bone health. However, certain medications used to treat the disease, and some behaviors triggered by concern over the disease can have a negative impact on the skeleton. This article discusses approaches for optimizing bone health for people with asthma.

The Asthma-Osteoporosis Connection

People with asthma tend to be at increased risk for osteoporosis, especially in the spine, for several reasons. First, anti-inflammatory medications, known as corticosteroids, are commonly prescribed for asthma. Taken by mouth, these medications can decrease calcium absorbed from food, increase calcium loss from the kidneys, and decrease bone formation. Corticosteroids also interfere with the production of sex hormones in both women and men, which can contribute to bone loss, and they can cause muscle weakness, which can increase the risk of falling.

Many asthma sufferers think that milk and dairy products trigger asthmatic attacks, although there is little evidence to support this belief unless the person has a dairy allergy. Unfortunately, this often results in an unnecessary avoidance of dairy products and is especially damaging for asthmatic children who need calcium to build bone.

Since exercise often can trigger an asthma attack, many people with asthma avoid weight-bearing physical activities that are known to strengthen bone. Those asthmatics who remain physically active often choose swimming as their first exercise of choice because it is the least likely activity to trigger an asthmatic attack. Unfortunately, swimming does not have the same beneficial impact on bone health as weight-bearing exercises that work the body against gravity, such as walking, jogging, racquet sports, basketball, volleyball, aerobics, dancing or weight-training.

Medications for Asthma

Because of their effectiveness in controlling asthma with the fewest side effects, inhaled corticosteroid medication is preferred to oral forms for asthma. Oral corticosteroids, which can cause significant bone loss over time, may be necessary for some asthmatics. Asthma patients who are treated with 40 to 60 mg per day of oral corticosteroids for long periods of time are most likely to experience bone loss. Even those patients who take 10 mg per day are likely to experience some bone loss over time.

Strategies to Optimize Bone Health

The following tips can help individuals with asthma to maximize their bone health.

Use medications prudently. Bone loss tends to increase with increased glucocorticoid doses and prolonged use. No matter which form of medication is used, the lowest possible dose for the shortest period of time that controls asthma symptoms is recommended. There are other medications available that also may relieve symptoms without causing bone loss, although for some people steroids are necessary.

Reduce exposure to triggers. Reducing exposure to those stimuli that appear to trigger asthma attacks lessens the patient’s reliance on medication.

Avoid Infection. Avoid people with colds and other respiratory infections whenever possible.

Minimize exposure to irritants. Avoid cigarette smoke, strong odors, air pollution, aerosol sprays, paint fumes, red wine, beer, food coloring, food dyes, sulfite food preservatives and extreme changes in temperature. Pay attention to air quality notices on your local weather stations.

Reduce contact with allergens. Since asthma symptoms can be triggered by allergies, avoid known allergens, and when possible remove allergens from the home, school, or work environment. Common household allergens include animal dander, dust mites, pollen, molds, and dust.

Monitor nutrition. A balanced diet with adequate amounts of calcium and vitamin D is critical for bone health. People with asthma who have a proven milk allergy should explore non-dairy sources of calcium and consider calcium supplementation in order to obtain enough calcium. The National Institutes for Health (NIH) recommends 400 to 600 mg of elemental calcium for infants, 800 to 1200 mg for children ages one to ten, and 1200 to 1500 mg for adolescents and young adults ages 11 – 24. For both children and adults on chronic corticosteroid therapy, some health care providers routinely recommend a daily elemental calcium intake of between 1000 and 1500 mg. Experts also recommend a daily vitamin D intake of between 400 and 800 IU per day.

Exercise. Weight-bearing activity, such as walking, running, weight-training, and team sports can all have a positive impact on bone health and participation should be encouraged. By improving muscle strength and coordination, exercise also can reduce the risk for falling and breaking bones. People who experience exercise-induced asthma should exercise in an environmentally controlled facility and participate in activities that fall within their limitations. They may also use medication when necessary to enable them to exercise.

Stress Reduction. If asthma is triggered by emotional stress, patients should consider participating in stress reduction programs.

Making the Osteoporosis Diagnosis

Asthmatics who must rely on corticosteroids to manage their asthma are at significant risk for bone loss and may benefit from a bone density test, which is the only accurate way to measure current bone mass, diagnose osteoporosis and predict future fracture risk. This information can help determine if medication is needed to prevent or treat bone loss. Since corticosteroids may increase bone resorption, blood or urine biochemical marker tests can be used to determine if bone is being broken down rapidly.

Medications to Prevent and Treat Bone Loss

Several medications are available for the prevention and/or treatment of osteoporosis. These medications can help prevent bone loss and reduce the risk of fracture. Asthmatics, particularly those taking corticosteroids, are encouraged to ask their health care providers whether they might be a candidate for an osteoporosis medication.