Kwok Wang Chun, Tsui Chung Ki, Leung Sze Him Isaac, Ngai Shuk Man, Lam David Chi Leung, Ip Mary Sau Man, Ho James Chung Man
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
Department of Statistics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
Clin Respir J. 2025 May;19(5):e70086. doi: 10.1111/crj.70086.
Inhaled corticosteroid (ICS) is a major pharmacotherapy for chronic obstructive pulmonary disease (COPD), which is associated with various adverse effects. Controversies exist in whether ICS use in COPD is associated with osteoporosis or fracture.
We performed a systematic review and meta-analysis to assess the risks of osteoporosis or fracture at different dosing levels of ICS. High-, medium- and low-dose ICS were defined according to the Global Initiative for Asthma (GINA) step definition.
Cochrane, EMBASE, Ovid, PubMed and Web of Science were systematically searched until 8 December 2023.
Osteoporosis or fracture under ICS therapy was chosen as the primary efficacy outcome. Three reviewers were involved independently in the extraction process. The risk of bias of the included studies was evaluated by using different assessment tools.
Twenty-one RCTs and eight observational studies were included. High-dose ICS was associated with increased risks of osteoporosis or fracture in RCTs with RR of 1.14 (95% CI = 1.03-1.28), observational studies with healthy controls 1.14 (95% CI = 1.05-1.24) and observational studies without healthy controls 1.10 (95% CI = 1.01-1.21). High-dose ICS was associated with increased risks in fracture in RCTs with RR of 1.12 (95% CI = 1.03-1.23), observational studies with health controls 1.15 (95% CI = 1.05-1.25) and observational studies without healthy controls 1.13 (95% CI = 1.03-1.24). Medium- and low-dose ICS were not associated with osteoporosis or fracture.
High-dose, but not medium- and low-dose, ICS use in COPD is associated with risks of osteoporosis or fractures.
吸入性糖皮质激素（ICS）是慢性阻塞性肺疾病（COPD）的主要药物治疗方法，但它会引发各种不良反应。ICS用于COPD是否会导致骨质疏松或骨折存在争议。
我们进行了一项系统评价和荟萃分析，以评估不同剂量水平的ICS导致骨质疏松或骨折的风险。高、中、低剂量的ICS是根据全球哮喘防治创议（GINA）的分级定义来确定的。
系统检索了Cochrane、EMBASE、Ovid、PubMed和Web of Science数据库，检索截至2023年12月8日。
选择ICS治疗下的骨质疏松或骨折作为主要疗效指标。由三位审阅者独立进行提取过程。使用不同的评估工具对纳入研究的偏倚风险进行评估。
纳入了21项随机对照试验（RCT）和8项观察性研究。在RCT中，高剂量ICS与骨质疏松或骨折风险增加相关，风险比（RR）为1.14（95%置信区间[CI]=1.03-1.28）；在有健康对照的观察性研究中，RR为1.14（95%CI=1.05-1.24）；在无健康对照的观察性研究中，RR为1.10（95%CI=1.01-1.21）。在RCT中，高剂量ICS与骨折风险增加相关，RR为1.12（95%CI=1.03-1.23）；在有健康对照的观察性研究中，RR为1.15（95%CI=1.05-1.25）；在无健康对照的观察性研究中，RR为1.13（95%CI=1.03-1.24）。中、低剂量ICS与骨质疏松或骨折无关。
COPD患者使用高剂量而非中、低剂量ICS会增加骨质疏松或骨折的风险。
