Inhaled corticosteroids (ICS) and oral corticosteroids (OCS) used to treat asthma increase the risk of osteoporosis or fragility fracture, according to a study published in Thorax.
Researchers conducted two nested case-control studies using linked data from the Clinical Practice Research Datalink and Hospital Episode Statistics databases. In a cohort of patients with asthma, researchers separately identified patients with osteoporosis or fragility fracture. These patients were then matched based on gender, age, and practice to a control population.
Researchers observed a dose-response relationship between both cumulative dose and number of OCS/ICS prescriptions within the previous year and risk of osteoporosis or fragility fracture. After adjusting for confounding factors, patients receiving more OCS prescriptions (≥9 vs. 0) had a 4.50-fold increased risk of osteoporosis (95% confidence interval [CI], 3.21-6.11) and 2.16-fold increased risk of fragility fractures (95% CI, 1.56-3.32). For patients receiving more ICS prescriptions (≥11 vs. 0), the odds ratios were 1.60 for osteoporosis (95% CI, 1.22-2.10) and 1.31 for fragility fractures (95% CI, 1.02-1.68).
The cumulative dose had a similar impact—those receiving more OCS/ICS doses were at greater risk. The prevalence of patients taking ≥9 OCS and at least one bisphosphonate prescription was 50.6% for osteoporosis and 48.4% for fragility fracture.
“The findings suggest that exposure to OCS or ICS is an independent risk factors for bone health in patients with asthma. Steroid administration at the lowest possible level to maintain asthma control is recommended,” the researchers concluded.