{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T02:57:26Z","timestamp":1700276246878},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"833","license":[{"start":{"date-parts":[[1995,3,1]],"date-time":"1995-03-01T00:00:00Z","timestamp":794016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1995,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Inhaled steroids are increasingly advocated as first line treatment for mild asthma. Some studies suggest that inhaled steroids suppress bone formation as reflected by a fall in plasma osteocalcin. Spacers have been shown to increase the proportion of inhaled aerosol that is deposited in the lungs and to reduce the amount swallowed. We measured plasma osteocalcin levels to determine the effect on bone formation of inhaled beclomethasone dipropionate (BDP) with and without a 750 ml spacer in a double-blind, randomised, placebo-controlled, cross-over study. Twenty-six healthy male volunteers took BDP 500 micrograms (two puffs of Becloforte) together with two puffs of placebo, inhaled twice daily for seven days. One inhaler was taken directly while the other was inhaled through a 750 ml spacer. After a two week washout period, the inhalers were exchanged so that BDP was taken by the alternate route for a further seven days. Fasting plasma osteocalcin levels were measured at 09.00 h before and at the end of each week. After a week of BDP taken directly (without a spacer), osteocalcin levels fell from 11.8 (SEM 0.6) ng\/ml to 9.5 (SEM 0.5) ng\/ml (p &amp;lt; 0.001). After a week of BDP taken through a spacer, osteocalcin levels fell from 12.1 (SEM 0.5) ng\/ml to 11.1 (SEM 0.5) ng\/ml (p &amp;lt; 0.001). The fall in osteocalcin when a spacer was used was significantly less than when BDP was taken directly (p &amp;lt; 0.005). This is likely to be because the systemic effects on bone are caused by swallowed rather than inhaled BDP, and this is limited by the use of a spacer. Spacers should be more widely prescribed with inhaled steroids. Further prospective studies are indicated to evaluate whether spacers protect bone mass.<\/jats:p>","DOI":"10.1136\/pgmj.71.833.156","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T21:25:21Z","timestamp":1230585921000},"page":"156-159","source":"Crossref","is-referenced-by-count":16,"title":["A large volume spacer significantly reduces the effect of inhaled steroids on bone formation"],"prefix":"10.1093","volume":"71","author":[{"given":"K","family":"Meeran","sequence":"first","affiliation":[{"name":"Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital , Du Cane Road, London W12 OHS , UK"},{"name":"Division of Endocrinology and Metabolism"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J M","family":"Burrin","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, The London Hospital Medical College, Turner Street , London El 2AD , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K A","family":"Noonan","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, The London Hospital Medical College, Turner Street , London El 2AD , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C P","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, The London Hospital Medical College, Turner Street , London El 2AD , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P W","family":"Ind","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1995,3,1]]},"reference":[{"key":"ref_1","first-page":"83","article-title":"Pathogenesis and treatment ofsteroid osteoporosis. 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N Engl J Med 1991, 325: 425-6.","journal-title":"N Engl J Med"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1136\/thx.45.10.733","article-title":"Use of inhaled corticosteroids in patients with mild asthma","volume":"45","author":"Lorentzson, S.; Boe, J.; Eriksson, G.; Persson, G.","year":"1990","unstructured":"Lorentzson S, Boe J, Eriksson G, Persson G. Use of inhaled corticosteroids in patients with mild asthma. Thorax 1990; 45: 733-5.","journal-title":"Thorax"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1136\/bmj.305.6854.598","article-title":"Large volume spacers in asthma","volume":"305","author":"Keeley, D.","year":"1992","unstructured":"Keeley D. Large volume spacers in asthma. 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Am Rev Respir Dis 1982; 126: 670-5.","journal-title":"Am Rev Respir Dis"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1136\/thx.38.12.908","article-title":"Comparison of three techniques of inhalation on the airway response to terbutaline","volume":"38","author":"Cushley, M.; Lewis, R.; Tattersfield, A.","year":"1983","unstructured":"Cushley M, Lewis R, Tattersfield A. Comparison of three techniques of inhalation on the airway response to terbutaline. 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