Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Epidemiology and Public Health, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
Division of Respiratory Medicine, Clinical Science Building, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
Respir Med. 2021 May;181:106374. doi: 10.1016/j.rmed.2021.106374. Epub 2021 Mar 26.
Understanding the potential deleterious effects of corticosteroids on bone health in people with asthma is important when making treatment decisions. There is a need for clearer evidence to better quantify the risk and effect size.
Databases were systematically searched to identify studies reporting on bone mineral density (BMD) measurement and risk of osteoporosis or fracture, comparing people with asthma exposed to inhaled (ICS) or oral (OCS) corticosteroids, with nonexposed people with asthma and healthy controls. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method.
This review consists of 28 studies (six randomized control trials and 22 observational). There was no effect of ICS on bone loss both at spine and femoral neck in asthma. People with asthma receiving OCS were at greater risk of osteoporosis than nonexposed people with asthma (pooled HR = 1.76; 95%CI: 1.48 to 2.09; I=68%). Similarly, higher ICS exposure was associated with higher risk of osteoporosis (OR = 1.63; 95%CI: 1.33 to 1.99) and fracture (pooled OR = 1.19; 95%CI: 1.05 to 1.35; I=0%) when comparing people with asthma receiving ICS and not.
Patients with asthma exposed to OCS or high ICS doses become more susceptible to bone comorbidities. Striking the right balance between efficacy and safety of steroids in asthma is important to improve patients' quality of life.
了解皮质类固醇对哮喘患者骨骼健康的潜在有害影响对于做出治疗决策非常重要。需要更清晰的证据来更好地量化风险和效应大小。
系统地搜索数据库，以确定报告骨密度（BMD）测量和骨质疏松症或骨折风险的研究，比较接受吸入（ICS）或口服（OCS）皮质类固醇治疗的哮喘患者与未暴露于哮喘的患者和健康对照。数据进行叙述性综合，使用随机效应逆方差法进行了一系列荟萃分析。
本综述包括 28 项研究（6 项随机对照试验和 22 项观察性研究）。ICS 对哮喘患者脊柱和股骨颈的骨丢失没有影响。接受 OCS 治疗的哮喘患者骨质疏松症的风险高于未暴露于哮喘的患者（合并 HR=1.76；95%CI：1.48 至 2.09；I=68%）。同样，较高的 ICS 暴露与骨质疏松症（OR=1.63；95%CI：1.33 至 1.99）和骨折（合并 OR=1.19；95%CI：1.05 至 1.35；I=0%）的风险增加相关，比较接受 ICS 治疗和未接受 ICS 治疗的哮喘患者。
接受 OCS 或高 ICS 剂量治疗的哮喘患者更容易发生骨骼合并症。在哮喘中平衡类固醇的疗效和安全性非常重要，以提高患者的生活质量。
