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Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review.
Osteoporos Int. 2003 May; 14(3):179-90.OI

Abstract

Deleterious effect of oral corticosteroids on bone has been well documented, whereas this remains debated for inhaled ones (ICS). Our objectives were to analyze the effects of ICS on bone mineral density, fracture risk and bone markers. We performed an exhaustive systematic research of all controlled trials potentially containing pertinent data, peer-reviewed by a dedicated WHO expert group, and comprehensive meta-analyses of the data. Inclusion criteria were ICS, and BMD/markers/fractures in asthma/chronic obstructive pulmonary diseases (COPD) and healthy patients. Analyses were performed in a conservative fashion using professional dedicated softwares and stratified by outcome, study design and ICS type. Results were expressed as standardized mean difference/effect size (ES), relative risk (RR) or odds ratio (OR), depending on study design and outcome units. Publication bias was investigated. Twenty-three trials were reviewed; 11 papers fit the inclusion criteria and were assessed for the main analysis. Quality scores for the randomized controlled trials (RCTs) were 80%, 71% for the prospective cohort studies, and 78% for the retrospective cohort and cross-sectional studies. We globally assessed ICS effects on BMD and found deleterious effects: ES=0.61 (p=0.001) for healthy subjects, and ES=0.27 (p<0.001) for asthma/COPD patients. For these patients, this effect was 0.21 (p<0.01) at the lumbar spine, and 0.26 (p<0.001) at the hip or femoral neck. A single study evaluated the impact of ICS on hip fracture and reported an increased OR of 1.6 (1.24; 2.03). Lumbar fracture rate differences did not reach the level of statistical significance: 1.87 (0.5; 6.94). Osteocalcin and PICP were decreased and ICTP, pyridinoline and deoxypyridinoline levels were not significantly affected. Budesonide (BUD) appeared to be the ICS inducing the less deleterious effects on bone, followed by beclomethasone dipropionate (BDP) and triamcinolone (TRI). Publication bias investigation provided non-significant results. In our meta-analyses, BUD at a mean daily dose (SD) of 686 microg (158 microg), BDP at 703 microg (123 microg) and TRI at 1,000 microg (282 microg) were found to affect bone mineral density and markers in patients suffering from the two major respiratory diseases. These findings could have practical implication in the long-term management of asthmatic and COPD patients.

Authors+Show Affiliations

WHO Collaborating Center for Public Health Aspects of Osteoarticular Disorders, Liège, Belgium. florent.richy@ulg.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

12730758

Citation

Richy, Florent, et al. "Inhaled Corticosteroids Effects On Bone in Asthmatic and COPD Patients: a Quantitative Systematic Review." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 14, no. 3, 2003, pp. 179-90.
Richy F, Bousquet J, Ehrlich GE, et al. Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review. Osteoporos Int. 2003;14(3):179-90.
Richy, F., Bousquet, J., Ehrlich, G. E., Meunier, P. J., Israel, E., Morii, H., Devogelaer, J. P., Peel, N., Haim, M., Bruyere, O., & Reginster, J. Y. (2003). Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 14(3), 179-90.
Richy F, et al. Inhaled Corticosteroids Effects On Bone in Asthmatic and COPD Patients: a Quantitative Systematic Review. Osteoporos Int. 2003;14(3):179-90. PubMed PMID: 12730758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inhaled corticosteroids effects on bone in asthmatic and COPD patients: a quantitative systematic review. AU - Richy,Florent, AU - Bousquet,Jean, AU - Ehrlich,George E, AU - Meunier,Pierre J, AU - Israel,Elliot, AU - Morii,Hirotoshi, AU - Devogelaer,Jean-Pierre, AU - Peel,Nicola, AU - Haim,Muriel, AU - Bruyere,Olivier, AU - Reginster,Jean-Yves, Y1 - 2003/04/23/ PY - 2003/01/24/received PY - 2003/01/27/accepted PY - 2003/5/6/pubmed PY - 2006/10/31/medline PY - 2003/5/6/entrez SP - 179 EP - 90 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 14 IS - 3 N2 - Deleterious effect of oral corticosteroids on bone has been well documented, whereas this remains debated for inhaled ones (ICS). Our objectives were to analyze the effects of ICS on bone mineral density, fracture risk and bone markers. We performed an exhaustive systematic research of all controlled trials potentially containing pertinent data, peer-reviewed by a dedicated WHO expert group, and comprehensive meta-analyses of the data. Inclusion criteria were ICS, and BMD/markers/fractures in asthma/chronic obstructive pulmonary diseases (COPD) and healthy patients. Analyses were performed in a conservative fashion using professional dedicated softwares and stratified by outcome, study design and ICS type. Results were expressed as standardized mean difference/effect size (ES), relative risk (RR) or odds ratio (OR), depending on study design and outcome units. Publication bias was investigated. Twenty-three trials were reviewed; 11 papers fit the inclusion criteria and were assessed for the main analysis. Quality scores for the randomized controlled trials (RCTs) were 80%, 71% for the prospective cohort studies, and 78% for the retrospective cohort and cross-sectional studies. We globally assessed ICS effects on BMD and found deleterious effects: ES=0.61 (p=0.001) for healthy subjects, and ES=0.27 (p<0.001) for asthma/COPD patients. For these patients, this effect was 0.21 (p<0.01) at the lumbar spine, and 0.26 (p<0.001) at the hip or femoral neck. A single study evaluated the impact of ICS on hip fracture and reported an increased OR of 1.6 (1.24; 2.03). Lumbar fracture rate differences did not reach the level of statistical significance: 1.87 (0.5; 6.94). Osteocalcin and PICP were decreased and ICTP, pyridinoline and deoxypyridinoline levels were not significantly affected. Budesonide (BUD) appeared to be the ICS inducing the less deleterious effects on bone, followed by beclomethasone dipropionate (BDP) and triamcinolone (TRI). Publication bias investigation provided non-significant results. In our meta-analyses, BUD at a mean daily dose (SD) of 686 microg (158 microg), BDP at 703 microg (123 microg) and TRI at 1,000 microg (282 microg) were found to affect bone mineral density and markers in patients suffering from the two major respiratory diseases. These findings could have practical implication in the long-term management of asthmatic and COPD patients. SN - 0937-941X UR - https://www.unboundmedicine.com/medline/citation/12730758/Inhaled_corticosteroids_effects_on_bone_in_asthmatic_and_COPD_patients:_a_quantitative_systematic_review_ L2 - https://doi.org/10.1007/s00198-003-1398-z DB - PRIME DP - Unbound Medicine ER -