Long-term intranasal corticosteroids vs. antihistamines and bone health in post-menopausal women with allergic rhinitis: a retrospective cohort study

The study examined the effects of long-term intranasal corticosteroid (INCS) use on bone health in 691 post-menopausal women with allergic rhinitis followed from 2015 to 2023. Women were divided into four groups: INCS users (198 women), second-generation antihistamine users (187 women), combination therapy users (156 women), and controls (150 women). During a median follow-up of 4.2 years, INCS users showed significantly greater decline in bone mineral density compared to controls. Osteoporosis occurred in 24.2% of INCS users versus 11.3% in controls. The risk of fractures was 3.85 times higher in INCS users. Antihistamines did not cause increased risk of bone loss or fractures. Higher risk was observed in women older than 65 years and those with lower body mass index.