Li Pen, Ghazala Laith, Wright Erin, Beach Jeremy, Morrish Donald, Vethanayagam Dilini
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Clin Invest Med. 2015 Apr 8;38(2):E23-30. doi: 10.25011/cim.v38i1.22573.
Steroids, inhaled and systemic, are used to treat airway inflammation in patients with asthma; however, steroids are recognized to cause a number of side effects, including osteoporosis. We evaluated the prevalence of osteopenia/osteoporosis in patients with moderate-severe asthma managed through the Edmonton Regional Severe Asthma Centre.
We performed a retrospective chart review and analyzed 57 charts on patients with moderate-severe asthma followed through the specialty clinic, and recorded their bone mineral density (BMD). Steroid use was reviewed and the frequency of osteopenia/osteoporosis was compared in patients requiring continuous systemic steroids (Group 1, n=15), intermittent systemic steroids (Group 2, n=15) or inhaled steroids only (Group 3, n=27).
The mean age (mean±SD) was 50±14.8 years. Cumulative systemic steroid dose of prednisone equivalent was higher in Group 1 (12.5 mg/day) than Group 2 (3.2 mg/day) (p=0.002). The frequency of osteopenia / osteoporosis was not significantly different between patients in Group 1(67%) and Group 2 (53%, p=0.46) but was significantly greater in patients from Group 1 in comparison with Group 3 (33%, p=0.038).
Patients with moderate-severe asthma have a high prevalence of reduced bone density. Many patients treated with intermittent systemic steroids for exacerbations, or who were stable on inhaled steroids, had either osteopenia or osteoporosis before the age of 50. National and international osteoporosis guidelines should emphasize earlier screening for asthma patients; and increase awareness of the detrimental effects of short-term systemic steroids and inhaled steroids on BMD, especially when started at an early age and in northern climates.
吸入性和全身性类固醇用于治疗哮喘患者的气道炎症；然而，类固醇会引发多种副作用，包括骨质疏松。我们评估了通过埃德蒙顿地区重症哮喘中心治疗的中重度哮喘患者中骨质减少/骨质疏松的患病率。
我们进行了一项回顾性病历审查，分析了57例通过专科门诊随访的中重度哮喘患者的病历，并记录了他们的骨密度（BMD）。审查了类固醇的使用情况，并比较了需要持续全身性类固醇治疗的患者（第1组，n = 15）、间歇性全身性类固醇治疗的患者（第2组，n = 15）或仅使用吸入性类固醇治疗的患者（第3组，n = 27）中骨质减少/骨质疏松的发生率。
平均年龄（均值±标准差）为50±14.8岁。第1组（12.5毫克/天）泼尼松等效物的累积全身性类固醇剂量高于第2组（3.2毫克/天）（p = 0.002）。第1组（67%）和第2组（53%）患者中骨质减少/骨质疏松的发生率无显著差异（p = 0.46），但与第3组（33%）相比，第1组患者的发生率显著更高（p = 0.038）。
中重度哮喘患者骨密度降低的患病率很高。许多因病情加重接受间歇性全身性类固醇治疗或使用吸入性类固醇病情稳定的患者在50岁之前就已出现骨质减少或骨质疏松。国家和国际骨质疏松指南应强调对哮喘患者进行更早的筛查；并提高对短期全身性类固醇和吸入性类固醇对骨密度有害影响的认识，尤其是在早年开始使用且处于北方气候条件下时。
