Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies

  title={Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies},
  author={Christos V. Chalitsios and Dominick E. Shaw and Tricia M. McKeever},
  pages={21 - 28}
Background Inhaled (ICS) and oral (OCS) corticosteroids are used widely in asthma; however, the risk of osteoporosis and fragility fracture (FF) due to corticosteroids in asthma is not well-established. Methods We conducted two nested case-control studies using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. Using an asthma cohort, we separately identified patients with osteoporosis or FF and gender-, age- and practice-matched… 

Fracture risk associated with glucocorticoid-induced osteoporosis in Japan

The use of glucocorticoids was associated with an increase in the incidence of osteoporotic fractures and tended to be higher in subgroups of patients with rheumatoid arthritis, asthma, COPD and in those aged < 65 years.

Risk of subtrochanteric and femoral shaft fractures due to bisphosphonate therapy in asthma: a population-based nested case–control study

To improve AFF prevention, early signs which may warrant imaging, such as prodromal thigh pain, should be discussed and regular review of bisphosphonates should occur in patients with asthma.

Osteoporosis and fracture risk with corticosteroids used for asthma

  • Medicine
    Drug and Therapeutics Bulletin
  • 2021
Risk of osteoporosis and fragility fractures in asthma due to oral and inhaled corticosteroids: two population-based nested case-control studies.

Overuse of Oral Corticosteroids, Underuse of Inhaled Corticosteroids, and Implications for Biologic Therapy in Asthma

High OCS use in Dutch GINA 4–5 asthma patients was common, however, in 4 out of 5 patients adherence to inhaled corticosteroid therapy and/or inhalation technique was considered suboptimal.

Frequency of Vitamin D Deficiency in Patients of Asthma

The frequency of vitamin D deficiency is very high in patients with asthma and these suboptimal levels are significantly influenced by the age of the patient and the duration of the disease.

Reducing Tolerance for SABA and OCS towards the Extreme Ends of Asthma Severity

OCS should be considered as a temporary option, mainly for the treatment of asthma exacerbations, and as a maintenance treatment only for a minority of patients with severe asthma, after ensuring good inhaler technique, modification of all possible contributory factors and comorbidities, and optimized pharmacotherapy using all other add-on treatments including biologics in the armamentarium of anti-asthma medication.

Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update

These guidelines are particularly intended to general practitioners and primary care physicians who prescribe GC treatments in LATAM to guide their daily clinical practice in terms of evaluation, prevention and treatment of GIO.

Limited side effects of asthma treatment on growth and bone health in children

The results showed a significant height reduction in children with current treatment at age 6 years compared with children with no treatment or a cumulative ICs dosage less than 10 weeks of standard treatment, and this association was also found when analysing ICs use and height up to 3 years of age.

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

The results summarized the currently available evidence about the multilevel interactions between osteosarcopenia and COPD to pave the way for a comprehensive approach targeting the most common risk factors of these pathological conditions.

Osteoporosis in Patients With Respiratory Diseases

The characteristics of osteoporosis in some respiratory diseases including COPD, asthma, COVID-19, tuberculosis, and lung cancer were concluded and it was revealed that hypoxia was the common pathogenesis of osteoclastogenesis secondary to respiratory diseases, with malnutrition and corticosteroid abuse driving the progression of osteopsorosis.



Use of inhaled corticosteroids and the risk of fracture.

New approach in which data on people with airflow obstruction from a large Medical Research Council study of the assessment and management of older people in the community with longitudinal data from their computerized general practice records provides further evidence that inhaled corticosteroid use is an independent risk factor for fracture.

Inhaled corticosteroids and hip fracture: a population-based case-control study.

In older subjects, the recent use of inhaled corticosteroid use and hip fracture is associated with a dose-related increase in hip fracture, even after adjusting for the annual number of courses of oral Corticosteroids.

A retrospective database study of oral corticosteroid and bisphosphonate prescribing patterns in England

Although OCS use is positively associated with BP prescription, variation among practices and CCGs exists and the variation in prescribing suggests there is still a need to improve GIOP prevention.

Inhaled and nasal corticosteroid use and the risk of fracture.

The long-term use of inhaled and nasal corticosteroids at the usual recommended doses is not associated with a risk of fracture in older patients with respiratory disease.

Use of Oral Corticosteroids and Risk of Fractures

The results quantify the increased fracture risk during oral corticosteroid therapy, with greater effects on the hip and spine than forearm, which has implications for the use of preventative agents against bone loss in patients at highest risk.

Effects of inhaled corticosteroid and short courses of oral corticosteroids on bone mineral density in asthmatic patients : a 4-year longitudinal study.

ICS therapy per se does not affect BMD, whereas frequent SC-OCS may do so, and as a whole, lumbar BMD was unchanged during the course of the study, whereas the Z score increased significantly.

Use of Inhaled Corticosteroids and Risk of Fractures

  • T. van StaaH. LeufkensC. Cooper
  • Medicine
    Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
  • 2000
It is concluded that users of inhaled corticosteroids have an increased risk of fracture, particularly at the hip and spine, however, this excess risk may be related more to the underlying respiratory disease than to inhaled Corticosteroid.

Bone mineral density in perimenopausal women with asthma: a population-based cross-sectional study.

Although BMDs were not significantly decreased in the asthmatics who had used inhaled corticosteroids, the duration of use correlated negatively with spinal BMD and was also associated with spinalBMD in multiple regression analysis.