Bone health in asthma: a twofold effect of disease and pharmacotherapy

Asthma is a chronic inflammatory airway disease with high global prevalence. Its persistent systemic inflammation and long-term treatments pose significant risks to bone health. This article aims to systematically elucidate the mechanisms by which asthma affects bone health and the corresponding clinical management strategies. Chronic inflammation disrupts bone metabolism through immune dysregulation, pro-inflammatory cytokine release, and oxidative stress, enhancing bone resorption and suppressing formation. Disease-related physical inactivity and common vitamin D (VitD) deficiency further impair bone health by reducing mechanical loading and altering endocrine regulation. Pharmacologically, long-term or high-dose glucocorticoids (GCs) therapy significantly lowers bone mineral density and increases fracture risk. Based on these mechanisms, comprehensive management strategies include optimizing inhaled therapies and judicious use of natural medicines to limit GCs exposure. Future research should clarify molecular mechanisms of the lung-bone axis, develop risk assessment models integrating inflammatory markers and cumulative GCs exposure, and implement routine bone health monitoring for high-risk populations. Multidisciplinary collaboration among respiratory medicine, paediatrics, and orthopaedics is essential to balance asthma control with preservation of bone health.