While it is beyond the scope and word limits of this editorial to examine the adverse impact on bone health of ICSs in a scientifically rigorous fashion, such an examination is critical. And fortunately, a meta-analysis of all rigorous, controlled studies of ICSs and bone density or fractures (including randomized controlled trials, and prospective, retrospective and cross-sectional analyses) has been performed by Richy et al,4 who concluded from this meta-analysis that ICSs were associated with a 1.2- to 1.8-times increased risk of vertebral fracture and a 1.6-times increased risk of hip fracture. Furthermore, ICS use was associated with a lower bone density at the spine and hip as well as lower serum levels of the bone formation markers, osteocalcin and procollagen type 1 C-terminal propeptide. Budesonide at a mean (SD) daily dose of 686 ± 158 μg, beclomethasone at 703 ± 23 μg, and triamcinolone at 1,000 ± 282 μg were found to adversely affect bone density and bone formation markers in patients with asthma and COPD. These doses are at the upper end, but below the maximum, of the therapeutic dosing range, and well within the doses prescribed in patients with advanced or difficult-to-control lung disease. Triamcinolone use was associated the highest overall bone loss, followed by beclomethasone and budesonide, but the most important correlate of bone loss was the dose used, not the brand name of the ICS. There was insufficient data on fluticasone to draw any conclusions, probably because it has been available in the marketplace for a shorter period of time.