Asthma Linked to Increased Risk of Osteoporosis and Fragility Fractures

Sarfaroj Khan 

August 14, 2020


  • 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).


  • Possibility of misclassification of asthma, osteoporosis, and FF diagnoses.


Chalitsios CV, McKeever TM, Shaw DE. Incidence of osteoporosis and fragility fractures in asthma: a UK population-based matched cohort study. Eur. Respir. J.2020 Aug 06 [Epub ahead of print]. doi: 10.1183/13993003.01251-2020. PMID: 32764111.  View abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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