Xiaofei Jia, Lei Liu, Yanzhong Yang
Long-term INCS use in post-menopausal women was associated with accelerated bone loss, increased osteoporosis risk, and higher fracture rates in a dose-dependent manner. These findings raise concerns regarding the assumption of complete INCS skeletal safety in post-menopausal women and suggest the need for enhanced bone monitoring in this population.
BACKGROUND: Intranasal corticosteroids (INCS) are first-line therapy for allergic rhinitis (AR), but their long-term skeletal safety in post-menopausal women-who are inherently vulnerable to bone loss-remains inadequately studied despite low systemic bioavailability.
METHODS: This retrospective cohort study included 691 post-menopausal women with persistent AR treated from 2015 to 2023. Participants were categorized into INCS (n = 198), second-generation antihistamine (sgAH, n = 187), combination therapy (n = 156), and control (n = 150) groups. Primary outcomes were changes in bone mineral density (BMD) T-scores and incident osteoporosis. Secondary outcomes included fragility fractures. Multivariable regression analyses were performed with adjustment for confounders, and dose-response relationships were evaluated using defined daily doses.
RESULTS: Over a median follow-up of 4.2 years, INCS users exhibited significantly greater declines in lumbar spine T-scores compared to controls, with similar findings at the femoral neck. sgAH users showed no significant bone loss. Dose-response analysis revealed linear trends for greater bone loss with higher cumulative INCS exposure. Incident osteoporosis occurred in 24.2% of INCS users vs. 11.3% of controls. Fragility fracture rates were highest in the INCS group with adjusted HR 3.85 (95% CI = 1.45-10.24, p = 0.007) vs. controls. sgAH showed no increased fracture risk (HR 1.13, 95% CI = 0.33-3.89). Subgroup analyses identified heightened risk in women aged ≥65 years and those with BMI < 23 kg/m2.
CONCLUSIONS: Long-term INCS use in post-menopausal women was associated with accelerated bone loss, increased osteoporosis risk, and higher fracture rates in a dose-dependent manner. These findings raise concerns regarding the assumption of complete INCS skeletal safety in post-menopausal women and suggest the need for enhanced bone monitoring in this population.