Inhaled Corticosteroids

Regarding inhaled corticosteroids (ICS) used in asthma and COPD management, all of the following statements are correct EXCEPT:

A 52-year-old man with chronic obstructive pulmonary disease (COPD) has been prescribed inhaled beclomethasone dipropionate 200 µg twice daily for 8 months. His serum cortisol level is normal, but he reports easy bruising and skin fragility. What is the most common systemic adverse effect of inhaled corticosteroids in long-term use that could explain these findings?

Which inhaled corticosteroid has the highest topical potency and lowest systemic bioavailability due to extensive first-pass hepatic metabolism?

A 52-year-old man with COPD on inhaled beclomethasone dipropionate 200 µg twice daily for 2 years presents with progressive bone pain and a history of multiple fragility fractures. To evaluate the extent of bone loss attributable to chronic ICS use, which investigation is most appropriate?

A 38-year-old woman with moderate persistent asthma has been on inhaled fluticasone propionate 250 µg twice daily for 6 months. She reports hoarseness and oral candidiasis. To assess local adverse effects and guide further management, which investigation is most appropriate?