哮喘患者容易出现骨质流失吗？

Are asthmatic patients prone to bone loss?

机构信息

Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Ann Allergy Asthma Immunol. 2014 May;112(5):426-31. doi: 10.1016/j.anai.2014.02.013. Epub 2014 Mar 18.

DOI:10.1016/j.anai.2014.02.013

PMID:24650445

Abstract

BACKGROUND

Recent studies suggest an association between allergic diseases, including asthma, and lower vitamin D level, a well-known risk factor of osteoporosis. However, it is not yet clearly known whether patients with asthma are prone to bone loss.

OBJECTIVE

To evaluate whether the occurrence of airway hyperresponsiveness (AHR) or asthma is related to significant changes in bone mineral density (BMD).

METHODS

We retrospectively enrolled 7,034 patients who had undergone a health checkup program, including BMD tests and methacholine bronchial challenge tests, at the Seoul National University Hospital, Healthcare System Gangnam Center, from November 1, 2004 to April 30, 2011. Asthma was ascertained by self-reported medical diagnosis by a physician. Patients with a history of systemic corticosteroid medication use were excluded from the study.

RESULTS

Among a total of 7,034 patients, 216 (3.1%) had a positive AHR test result, and 217 (3.1%) had a history of asthma. Lumbar spine and femur BMD of patients with AHR were significantly lower than those without AHR (-0.53 ± 1.50 vs -0.03 ± 1.49, -0.47 ± 0.97 vs -0.22 ± 0.99, respectively; P < .001 for both). After being adjusted for age, sex, body mass index, smoking status, postmenopausal state, and previous history of hormone replacement therapy, the proportion of patients with osteopenia or osteoporosis was much higher in the AHR-positive group than in the AHR-negative group (odds ratio, 1.715; 95% confidence interval, 1.252-2.349) and in the ever-asthma group than in the never-asthma group (odds ratio, 1.526; 95% confidence interval, 1.120-2.079).

CONCLUSION

In the current study, AHR and asthma were related to clinically meaningful BMD decrease, although the causal relationship is unclear.

摘要

背景

最近的研究表明，包括哮喘在内的过敏性疾病与维生素 D 水平降低有关，而维生素 D 水平降低是骨质疏松的一个已知危险因素。然而，目前尚不清楚哮喘患者是否容易发生骨丢失。

目的

评估气道高反应性（AHR）或哮喘的发生是否与骨矿物质密度（BMD）的显著变化有关。

方法

我们回顾性纳入了 2004 年 11 月 1 日至 2011 年 4 月 30 日期间在首尔国立大学医院保健系统江南中心接受健康体检项目（包括 BMD 测试和乙酰甲胆碱支气管激发试验）的 7034 例患者。哮喘通过医生报告的医疗诊断确定。排除有全身皮质类固醇药物使用史的患者。

结果

在总共 7034 例患者中，216 例（3.1%）检测到 AHR 阳性，217 例（3.1%）有哮喘病史。AHR 阳性患者的腰椎和股骨 BMD 明显低于 AHR 阴性患者（-0.53 ± 1.50 比 -0.03 ± 1.49，-0.47 ± 0.97 比 -0.22 ± 0.99；P <.001）。在校正年龄、性别、体重指数、吸烟状况、绝经状态和激素替代治疗史后，AHR 阳性组患者骨量减少或骨质疏松症的比例明显高于 AHR 阴性组（比值比，1.715；95%置信区间，1.252-2.349），且在曾患哮喘组高于从未患哮喘组（比值比，1.526；95%置信区间，1.120-2.079）。