Asthma and chronic obstructive airway diseases are associated with osteoporosis and fractures: a literature review.
The objective was to assess the association between asthma and/or chronic obstructive airway diseases (COAD), and osteoporosis, and appraise treatments of osteoporosis in these patients. MEDLINE and Excerpta Medica were searched for original research with control groups which tested the above association. One cohort and nine cross-section studies of bone density in patients with asthma and/or COAD were retrieved. These demonstrated clinically important bone density reductions of up to 29% in subjects, dependent upon daily oral corticosteroids, by a variety of measurement techniques, at various bone sites. Bone density reduction has also been less consistently reported in the absence of oral corticosteroids, suggesting that other factors including high-dose inhaled corticosteroids may have a role. Fracture studies. Three studies in oral corticosteroid-dependent asthmatics demonstrated a vertebral fracture prevalence up to 56%, and annual vertebral fracture incidence of up to 42%. The strength of the available evidence is limited, but suggests that patients with asthma and/or COAD are at increased risk of osteoporosis. The evidence of the association between osteoporosis and inhaled corticosteroids is much more limited than for oral corticosteroids. Bisphosphonates are promising agents to maintain and/or promote bone mass in this patient group.
Smith
B J
BJ
Department of Medicine, Queen Elizabeth Hospital, Adelaide, South Australia. bsmith@tqehsmtp.tqeh.sa.gov.au
Phillips
P J
PJ
Heller
R F
RF
D000280:Administration, Inhalation; D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D015519:Bone Density; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000188:drug therapy; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D013256:Steroids; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D013256:Steroids