Langhammer Arnulf, Forsmo Siri, Lilleeng Solfrid, Johnsen Roar, Bjermer Leif
HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Neptunveien 1, 7650 Verdal, Norway.
Respir Med. 2007 Aug;101(8):1744-52. doi: 10.1016/j.rmed.2007.02.018. Epub 2007 Apr 11.
To study the effect of inhaled corticosteroid (ICS) on bone mineral density (BMD) in an observational longitudinal study.
In 1995-97, as part of the Nord-Trøndelag Health Study, Norway, 10,941 subjects aged 20 yr or more, either reporting asthma diagnosis/asthma-related symptoms or randomly selected, were interviewed, underwent spirometry and had their forearm BMD assessed. Among these, 4705 persons were invited to follow-up interview and bone densitometry in 2001; a total of 2848 subjects were eligible for analyses.
Use of corticosteroids for respiratory diseases was reported by 1262 subjects, and 528 subjects had used ICS at both baseline and follow-up. The yearly loss of adjusted forearm distal BMD was higher in those reporting use of ICS at both baseline and follow-up compared to subjects without respiratory symptoms. In women the figures were 3.14 versus 2.26 mg/cm2, whilst in men they were 3.76 versus 1.92 mg/cm2 (both p<0.01). No significant association was found between loss of BMD and neither daily dose nor duration of ICS use. Reduced lung function (forced expiratory flow in 1s) was an independent risk factor for increased bone loss in both sexes.
ICS users had greater bone loss at the forearm compared to ICS naive persons, but no significant dose-response effect between ICS and BMD was found. Residual confounding by disease severity cannot be ruled out, but even in case of an ICS causal effect, this should have minor clinical significance in most patients using low to moderate doses of ICS.
在一项观察性纵向研究中，研究吸入性糖皮质激素（ICS）对骨矿物质密度（BMD）的影响。
1995年至1997年，作为挪威北特伦德拉格健康研究的一部分，对10941名20岁及以上的受试者进行了访谈，这些受试者要么报告有哮喘诊断/哮喘相关症状，要么是随机选取的，他们接受了肺活量测定，并对其前臂骨密度进行了评估。其中，4705人在2001年被邀请进行随访访谈和骨密度测定；共有2848名受试者符合分析条件。
1262名受试者报告使用过用于呼吸系统疾病的糖皮质激素，528名受试者在基线和随访时均使用过ICS。与无呼吸道症状的受试者相比，在基线和随访时均报告使用ICS的受试者调整后的前臂远端骨密度年丢失率更高。女性的数据分别为3.14和2.26mg/cm²，而男性的数据分别为3.76和1.92mg/cm²（均p<0.01）。未发现骨密度丢失与ICS的每日剂量或使用持续时间之间存在显著关联。肺功能降低（1秒用力呼气流量）是两性骨丢失增加的独立危险因素。
与未使用ICS的人相比，使用ICS的人前臂骨丢失更多，但未发现ICS与骨密度之间存在显著的剂量反应效应。不能排除疾病严重程度造成的残余混杂因素，但即使ICS存在因果效应，在大多数使用低至中等剂量ICS的患者中，这在临床上也应具有较小的意义。
