Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review

Area of Science:

• Pulmonary Medicine
• Endocrinology
• Bone Metabolism

Background:

• Oral corticosteroids are known to harm bone, but the skeletal effects of inhaled corticosteroids (ICS) are less clear.
• Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions often managed with ICS.

Purpose of the Study:

• To systematically review and meta-analyze the effects of ICS on bone mineral density (BMD), fracture risk, and bone turnover markers.
• To compare the bone-related effects of different types of ICS.

Main Methods:

• Systematic research of controlled trials involving ICS and BMD/markers/fractures in asthma/COPD patients and healthy individuals.
• Comprehensive meta-analyses stratified by outcome, study design, and ICS type.
• Publication bias was investigated.

Main Results:

• ICS were associated with deleterious effects on BMD in both healthy subjects (ES=0.61) and asthma/COPD patients (ES=0.27).
• Specific bone density reductions were observed at the lumbar spine (ES=0.21) and hip/femoral neck (ES=0.26) in respiratory patients.
• One study indicated an increased hip fracture risk (OR=1.6), while lumbar fracture rates were not significantly affected.
• Certain bone markers showed decreases (Osteocalcin, PICP), while others were unchanged (ICTP, pyridinoline, deoxypyridinoline).
• Budesonide (BUD) appeared to have less deleterious effects than beclomethasone dipropionate (BDP) and triamcinolone (TRI).

Conclusions:

• Inhaled corticosteroids exert detrimental effects on bone mineral density and markers in patients with asthma/COPD.
• The choice of ICS may influence the extent of bone impact, with budesonide potentially being a safer option.
• These findings have implications for the long-term management of respiratory diseases, emphasizing bone health monitoring.