Intervention Review

Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease

  1. Alan Jones1,*,
  2. Jeanne K Fay2,
  3. Michael L Burr3,
  4. Mike Stone4,
  5. Kerry Hood5,
  6. Gwyn Roberts6

Editorial Group: Cochrane Airways Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 10 OCT 2001

DOI: 10.1002/14651858.CD003537


How to Cite

Jones A, Fay JK, Burr ML, Stone M, Hood K, Roberts G. Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003537. DOI: 10.1002/14651858.CD003537.

Author Information

  1. 1

    University of Wales College of Medicine, Department of General Practice, Cardiff, Wales, UK

  2. 2

    St Bartholomew's Medical Centre, Oxford, UK

  3. 3

    University College of Medicine, Centre for Applied Public Health Medicine, Cardiff, UK

  4. 4

    University of Wales College of Medicine, The Bone Research Unit,, Penarth, Cardiff, UK

  5. 5

    Cardiff University, Department of Primary Care and Public Health, School of Medicine, Cardiff, Wales, UK

  6. 6

    University of Wales College of Medicine, Dept. of General Practice at Gorseinon, Gorseinon, Swansea, UK

*Alan Jones, Department of General Practice, University of Wales College of Medicine, Cardiff, Wales, UK. airways@sgul.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2002

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Inhaled corticosteroids form the main therapy for asthma, but there is increasing concern about the potential systematic effects of long-term inhaled corticosteroids including their effect on bone metabolism and bone loss.

Objectives

To determine the effect of inhaled corticosteroids use on biochemical markers of bone turnover, bone mineral density and the development of fractures.

Search methods

We searched the Cochrane Airways Group trials register, electronic reference databases, UK National Research Register, bibliographies of included studies, and contacted pharmaceutical companies.

Selection criteria

Randomised trials of the effect of inhaled steroid versus placebo on markers of bone function and metabolism, in adults with asthma or mild COPD.

Data collection and analysis

Trial quality was assessed and data extracted from the papers included (2 reviewers per paper) and from additional data supplied by the authors.

Main results

Of 438 references found, seven met the inclusion criteria. Three studies were in healthy subjects asthma or COPD. The patients were generally less than 60 years old and the male:female ratio was 2:1. There was no evidence of increased risk of loss of bone mineral density (BMD) or fractures. There was no significant change in osteocalcin at conventional doses of inhaled corticosteroids (Standardised Mean Difference [SMD] -0.34 (95% Confidence Interval [CI] -0.72, 0.04), although a statistically significant change was seen in those studies using experimental doses of inhaled steroid in excess of the doses recommended by the British Thoracic Society SMD 0.97 (95% CI -1.61, -0.34). A statistically significant change in parathyroid hormone seen in one small short trial (n=10, 6 weeks) may have been due to the trial design and outcome measurements used.

Authors' conclusions

In patients with asthma or mild COPD, there is no evidence of an effect of inhaled corticosteroid at conventional doses given for two or three years on BMD or vertebral fracture. Higher doses were associated with biochemical markers of increased bone turnover, but data on BMD and fractures at these doses are not available. There is a need for further, even longer term prospective studies of conventional and high doses of inhaled corticosteroids.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease

Usual doses of corticosteroids for two or three years for asthma does not weaken bones in younger patients, although long term outcomes and after high doses need more research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

吸入式皮質類固醇在氣喘及輕度慢性阻塞性肺病骨骼代謝的影響

吸入式皮質類固醇成為氣喘的主要治療,但長期使用吸入式皮質類固醇潛在的全身效應受到愈來愈多的關注,包括對骨骼代謝及骨質消失。

目標

確認使用吸入式皮質類固醇對骨骼代謝生化標誌、骨礦物質密度及發生骨折的效應。

搜尋策略

我們搜尋Cochrane Airways Group trials register、電子文獻資料庫、UK National Research Register、納入研究的引用文獻,以及聯繫藥品製造商。

選擇標準

比較吸入式類固醇與安慰劑對氣喘或輕度COPD的成人患者在骨功能及代謝標誌的效應之隨機試驗。

資料收集與分析

包括每一份文章皆由兩位審查者評估試驗品質及摘錄數據,並從作者處取得額外數據。

主要結論

在找到的438篇論文中有七篇符合納入標準。三項研究是涉及健康受試者、氣喘或COPD患者。整體上病人年齡小於60歲而男女比例為2:1。沒有證據顯示骨礦物質密度(BMD)喪失或骨折的風險有增加。雖然這些研究在使用吸入式類固醇的實驗劑量超過英國胸腔學會建議劑量時呈現有統計學意義的變化(標準化均數差﹝SMD﹞0.97;95%信賴區間﹝CI﹞−1.61至−0.34),但使用傳統劑量吸入式皮質類固醇對osteocalcin並無顯著的改變(SMD −0.34;95%CI −0.72至0.04)。一項小規模的試驗(n = 10,6星期)顯示副甲狀腺激素有統計學意義的變化,可能是由於試驗使用的設計及結果測量方法所致。

作者結論

在氣喘或輕度COPD病人,並無證據顯示傳統劑量吸入式皮質類固醇在使用二或三年的時間對BMD或脊椎骨折有所影響。較高劑量則伴隨生化標誌顯示骨骼代謝增加,但卻欠缺此等劑量有關BMD及骨折的數據。需要對傳統及高劑量之吸入式皮質類固醇有更進一步,甚至更長期的前瞻性研究。

翻譯人

本摘要由中國醫藥大學附設醫院陳祖裕翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用平常劑量的皮質類固醇治療氣喘二或三年的時間,並不會令較年輕的病人骨骼變弱,雖然高劑量的長期使用的結果需有更多的研究。