Takeaway
Asthma was associated with an increased risk of osteoporosis and fragility fractures (FF), particularly vertebral and humerus fractures.
This association was stronger in the younger age groups and in those with more frequent use of oral corticosteroids (OCS) and inhaled corticosteroids (ICS).
Why this matters
Findings highlight the need for increased awareness of these bone disease co-morbidities in asthma, particularly in the younger population.
Reviewing corticosteroid dose and using the lowest dose possible are recommended to reduce the risk of osteoporosis and FF in asthma.
Study design
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 UK Clinical Practice Research Database (CPRD).
Osteoporosis and FF incidence rates were compared.
Funding: British Medical Association.
Key results
The incidence of osteoporosis and FF was higher in asthma vs non-asthma group (5.25 vs 3.23 per 1000 person-years; adjusted HR [aHR], 1.18; 95% CI, 1.13-1.23 and 5.99 vs 4.97 per 1000 person-years; aHR, 1.12; 95% CI, 1.07-1.16, respectively).
The effect was stronger in younger people and slightly larger in men with asthma (Pinteraction<.0001 for both).
Forearm-wrist (aHR, 1.21; 95% CI, 1.13-1.30) and vertebral (aHR, 1.19; 95% CI, 1.10-1.28) were the sites associated with a higher risk.
Increasing OCS prescriptions raised the risk of osteoporosis, and those exposed to ≥9 OCS prescriptions per year of follow-up were at a greater risk vs non-exposed (aHR, 6.11; 95% CI, 5.31-7.02); FF risk increased in those with 6-8 courses per year (aHR, 1.35; 95% CI, 1.10-1.64).
Regular use of ICS prescription per year increased the risk of osteoporosis and FF; however, the risk was greater after the 17th prescription per year of follow-up (aHR, 10.66; 95% CI, 8.20-12.05 and aHR, 6.15; 95% CI, 2.37-13.21, respectively).
Limitations
Possibility of misclassification of asthma, osteoporosis, and FF diagnoses.
This clinical summary first appeared on Univadis, part of the Medscape Professional Network.
Cite this: Asthma Linked to Increased Risk of Osteoporosis and Fragility Fractures - Medscape - Aug 14, 2020.
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