SELECTED ARTICLES FROM THE RECENT LITERATURE 2004
10/14/04
Osteoporosis in patients with asthma or COPD
Summary
Background - There has been increasing concern about the impact of osteoporosis (Osteo) on morbidity, quality of life and even mortality in older individuals. Osteo is thought to be initially occult in most cases. It is characterized by a significant decrease (2 SD below the normal mean) in bone mineral density (BMD) and micro-architectural bone abnormalities which predispose to fractures. The fractures that occur (particularly in the hip) cause significant morbidity and a 10-20% excess mortality within one year.
Findings - LaRosa and Apter of the Univ of Pennsylvania Medical Center in Philadelphia reviewed whether patients with asthma or COPD are at increased risk for Osteo. They first pointed out that other factors such as history of previous fragility fractures, parental history of Osteo, post-menopausal female status are important risk factors for Osteo, independent of BMD. One also has to consider disease-related and medication-related secondary causes of Osteo.
In asthmatics, prolonged oral corticosteroid therapy is a definite risk factor for Osteo. However, daily use of inhaled corticosteroids (ICS) at doses of <1000 mcg/day appears to increase the risk for Osteo and resultant fractures on modestly, if at all. In contrast, several factors commonly present in patients with COPD, including long-term smoking, decreased body mass index and decreased mobility are definite increased risk factors for Osteo and resultant complications.
Reference
J Respir Dis 2004;25:377-84
Editor's Comments
This is a thoughtful, careful review of a subject in which there has been tremendous interest and a large amount of, sometimes, conflicting information. With regards to implications for management of asthma is concerned, I think that the authors' impression that treatment with daily ICS doses of <1000 mcg/day in adults is not a risk factor for Osteo is generally shared by most investigators. However, fluticasone, one of the most commonly used ICS may be associated with decreased BMD when used chronically at doses of more than 400 mcg/day. Fluticasone use at doses over 200mcg/day may be associated with decreased growth velocity in children.
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