Long-term intranasal corticosteroids vs. antihistamines and bone health in post-menopausal women with allergic rhinitis: a retrospective cohort study
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 198 participants or records.
Read the paper
Related studies
- Effectiveness of Bisphosphonates and Denosumab on Risk of Vertebral Fractures in Prostate Cancer Patients Under Androgen Deprivation Therapies: A Real-World Prospective Study
- Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil
- Serum 25-hydroxyvitamin D, parathyroid hormone, and mortality in older men
- Lack of Association between Vitamin D Insufficiency and Cardiovascular or Fracture Risk: A UK Biobank Study
- Muscle strength and body composition are clinical indicators of osteoporosis
- Incidence of bone protection and associated fragility injuries in patients with proximal femur fractures
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.