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Asthma tied to increased risk of osteoporosis and fragility fractures

Key clinical point: Asthma is associated with an increased risk of osteoporosis and fragility fractures (FF), particularly vertebral and humerus fractures.

Major finding: The risk of osteoporosis and FF was higher in asthma vs. non-asthma group (adjusted hazard ratio [aHR]: 1.18 and 1.12, respectively). The effect was stronger in younger age groups (Pinteraction less than .0001). Forearm-wrist (aHR, 1.21) and vertebra (aHR, 1.19) were the sites associated with a higher risk. Among patients with asthma, a single oral corticosteroid course increased the risk of osteoporosis, and greater use of inhaled corticosteroids increased the risk of both bone diseases.

Study details: This population-based matched cohort study included 138,123 patients with asthma and 520,626 age-, sex-, and practice-matched people without asthma using data from the U.K. Clinical Practice Research Datalink.

Disclosures: The study was funded by a research grant from the British Medical Association. The authors declared no conflicts of interest.

Commentary

“Inhaled and oral corticosteroids are commonly used for the treatment of asthma. Previous studies have shown that corticosteroids induce bone loss, which is dose dependent. In this matched cohort study conducted in the U.K., adults with an incident asthma code (N=138,123) were matched to 4 adults without asthma (N=520,626) by age, gender, and practice. The risk of osteoporosis was 18% higher in asthma vs. non-asthma group (adjusted hazard ratio [aHR]: 1.18), while the risk of fragility fracture was 12% higher (aHR:1.12). Younger individuals with asthma and those who used oral and inhaled corticosteroids more frequently were at particularly higher risk for osteoporosis and fragility fractures. These findings suggest the need for appropriate screening for osteoporosis and for the need of corticosteroid-sparing therapy in people living with asthma.”

Maria I. Danila, MD, MSc, MSPH

University of Alabama at Birmingham

Citation:

Chalitsios CV et al. Eur Respir J. 2020 Aug 6. doi: 10.1183/13993003.01251-2020.