Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Eur Respir J. 2021 Jan 21;57(1). doi: 10.1183/13993003.01251-2020. Print 2021 Jan.
Osteoporosis and fragility fractures are associated with corticosteroids which are the mainstay treatment for asthma; however, these bone comorbidities within asthma need to be better described.
A matched cohort study was conducted using the UK Clinical Practice Research Database (CPRD). Adults with an incident asthma code were identified and matched, with up to four randomly selected people without asthma, by age, sex and practice. Osteoporosis and fragility fracture incidence rates were calculated, and Cox regression was performed comparing hazard rates to the general population. We report the impact of age, sex, glucocorticoids and the risk of specific fractures.
Patients with asthma had a higher risk of osteoporosis (adjusted hazard ratio (aHR) 1.18, 95% CI 1.13-1.23) and were 12% (aHR 1.12, 95% CI 1.07-1.16) more likely to sustain fragility fractures than the general population. Age modified the effect of asthma on osteoporosis and fragility fractures, such that the effect was stronger in younger people (p<0.0001). The vertebra (aHR 1.40, 95% CI 1.33-1.48) and forearm/wrist (aHR 1.27, 95% CI 1.22-1.32) were the sites linked with a larger incidence. A dose-response relationship between oral corticosteroids (OCS) and osteoporosis was observed, whereas the risk of fragility fractures increased in those with six or more OCS courses per year. Regular use of inhaled corticosteroids (ICS) increased the risk of both bone conditions.
Patients with asthma are more likely to develop osteoporosis or sustain fragility fractures than the general population, with a particular concern in younger people and those more frequently using OCS and ICS.
骨质疏松症和脆性骨折与皮质类固醇有关，皮质类固醇是治疗哮喘的主要药物；然而，哮喘患者的这些骨骼合并症需要更好地描述。
使用英国临床实践研究数据库（CPRD）进行了一项匹配队列研究。确定了有新发哮喘代码的成年人，并通过年龄、性别和实践进行了最多四个随机选择的无哮喘的人进行匹配。计算了骨质疏松症和脆性骨折的发病率，并通过 Cox 回归比较了与一般人群的危险率。我们报告了年龄、性别、糖皮质激素和特定骨折风险的影响。
哮喘患者发生骨质疏松症的风险更高（调整后的危险比 (aHR) 1.18，95%CI 1.13-1.23），发生脆性骨折的风险比一般人群高 12%（aHR 1.12，95%CI 1.07-1.16）。年龄改变了哮喘对骨质疏松症和脆性骨折的影响，在年轻人中这种影响更强（p<0.0001）。椎体（aHR 1.40，95%CI 1.33-1.48）和前臂/手腕（aHR 1.27，95%CI 1.22-1.32）是与更高发病率相关的部位。观察到口服皮质类固醇（OCS）与骨质疏松症之间存在剂量反应关系，而每年使用六次或更多 OCS 疗程的患者脆性骨折的风险增加。常规使用吸入皮质类固醇（ICS）会增加这两种骨骼疾病的风险。
哮喘患者发生骨质疏松症或脆性骨折的风险高于一般人群，特别是年轻人和更频繁使用 OCS 和 ICS 的患者。
