Monadi M, Javadian Y, Cheraghi M, Heidari B, Amiri M
Department of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
Osteoporos Int. 2015 Jul;26(7):2013-8. doi: 10.1007/s00198-015-3089-y. Epub 2015 Apr 10.
The effect of inhaled corticosteroid on bone mineral density (BMD) was investigated in 44 asthmatic patients after median treatment duration of 6.5 years. Compared with controls, BMD decreased only in patients aged <50 years in both the spine (11.3 %, p = 0.013) and hip (8.8 %, p = 0.044), whereas in patients ≥50 years BMD did not decrease significantly.
The results of studies which addressed the impact of inhaled corticosteroid (ICS) therapy on BMD of patients with asthma are conflicting. This case-control study aimed to compare BMD status in ICS user with asthma with healthy controls according to age.
BMD at the lumbar spine (LS), femoral neck (FN) was measured by dual energy X-ray absorptiometry (DEXA). Patients and controls were compared according to BMD gr/cm(2), BMD T-score, BMD Z-score, frequency of osteoporosis (defined as BMD T-score ≤-2.5), and frequency of patients with BMD Z-score <-1 at LS and FN with regard to age <50 and ≥50 years old.
Forty-four ICS user patients (females 63.6 %) with median treatment duration of 6.5 years and 50 controls (females, 69.4 %) with respective mean age of 49.2 ± 9.5 and 47.4 ± 10.5 years (p = 0.38 and p = 0.35) entered the study. Overall LS-BMD and FN-BMD gr/cm2 in total patients were lower than in controls by 6 % (p = 0.065) and 5.9 % (p = 0.09), respectively. In patients <50 years, mean LS-BMD gr/cm(2) was lower than controls by 11.3 % (p = 0.013) and FN-BMD by 8.8 % (p = 0.044). Mean BMD T-score and BMD Z-score in both measurement sites were also lower than controls (p = 0.013 and 0.01, respectively. Frequency of osteoporosis did not differ but frequency of patients with BMD Z-score <-1 was significantly higher in patients (odds ratio (OR) = 6.57 95 % CI, 1.8-23.9, p = 0.004). In age group ≥50 years old, reduction of BMD in both measurement sites did not reach to a significant level.
This study indicates that BMD reduction in ICS user with asthma is dependent on age and appears that younger patients are at greater risk of BMD loss. These findings suggest preventive measures particularly in patients <50 years.
在44例哮喘患者中，研究了吸入性糖皮质激素对骨矿物质密度（BMD）的影响，这些患者的中位治疗时间为6.5年。与对照组相比，仅年龄＜50岁的患者脊柱（降低11.3%，p = 0.013）和髋部（降低8.8%，p = 0.044）的骨密度降低，而年龄≥50岁的患者骨密度无显著降低。
关于吸入性糖皮质激素（ICS）治疗对哮喘患者骨密度影响的研究结果相互矛盾。这项病例对照研究旨在根据年龄比较哮喘ICS使用者与健康对照组的骨密度状况。
采用双能X线吸收法（DEXA）测量腰椎（LS）、股骨颈（FN）的骨密度。根据骨密度（g/cm²）、骨密度T值、骨密度Z值、骨质疏松症发生率（定义为骨密度T值≤ -2.5）以及腰椎和股骨颈骨密度Z值＜ -1的患者发生率，比较年龄＜50岁和≥50岁的患者与对照组。
44例ICS使用者（女性占63.6%），中位治疗时间为6.5年，50例对照组（女性占69.4%），各自平均年龄分别为49.2 ± 9.5岁和47.4 ± 10.5岁（p = 0.38和p = 0.35）进入研究。总体而言，患者组腰椎骨密度和股骨颈骨密度（g/cm²）分别比对照组低6%（p = 0.065）和5.9%（p = 0.09）。在年龄＜50岁的患者中，平均腰椎骨密度（g/cm²）比对照组低11.3%（p = 0.013），股骨颈骨密度低8.8%（p = 0.044）。两个测量部位的平均骨密度T值和骨密度Z值也低于对照组（分别为p = 0.013和0.01）。骨质疏松症发生率无差异，但骨密度Z值＜ -1的患者发生率在患者组显著更高（优势比（OR）= 6.57，95%置信区间，1.8 - 23.9，p = 0.004）。在年龄≥50岁的组中，两个测量部位的骨密度降低未达到显著水平。
本研究表明，哮喘ICS使用者的骨密度降低取决于年龄，似乎年轻患者骨密度丢失风险更大。这些发现提示尤其对于年龄＜50岁的患者应采取预防措施。
