Question:

How specifically does ADVAIR affect osteoporosis? (e.g. does it impede calcium absorption?) Would an increase in calcium ingestion (what % or mg) offset this affect?

Answer:

Oral steroids known as glucocorticoids affect calcium and bone density in several ways.  To name a few; glucocorticoids reduce new bone formation and reduces calcium absorption from the intestinal system so less calcium reaches the blood stream to be used. 

The amount of bone loss (osteoporosis) is related to the steroid dose and the length of time it is used.

Inhaled steroids like Advair are much safer than oral steroids; however, small amounts of the steroids are absorbed into the blood stream so there will be some side effects.  Again, the effects will be dose dependent so the higher the inhaled steroid dose the more likely you will have side effects like bone loss.

Steroids are just one cause of osteoporosis.  Other causes include family history, race, low calcium intake, lack of physical activity, cigarette smoking, excessive alcohol intake, low body weight and low estrogen (menopause). 

To prevent osteoporosis your provider should use the least amount of steroids to control your asthma symptoms.  Additionally, try to prevent bone loss by stopping smoking; doing weight bearing exercise 3-4 times a weeks for 30 minutes; limit alcohol intake; and get enough calcium in your diet.  Adults at risk for osteoporosis should take 1,500 mg per day (divided over the day).  Vitamin D (400 units) is needed for absorption of calcium into the body.  Talk to your doctor before starting exercise if you have been inactive or about calcium supplements to make sure they will not interfere with your other medicines.

If you are on inhaled or oral steroids you can be checked for osteoporosis/bone loss by having a bone density test.  People on long term steroids generally get a bone density test once a year.

For more information:

Go to the Asthma health topic.