BackgroundOsteoporosis and fragility fractures (FF) are associated with corticosteroids which are the mainstay treatment for asthma; however, these bone comorbidities within asthma need to be better described.MethodsA matched cohort study was conducted using the Clinical Practice Research Database (CPRD). Adults with an incident asthma code were identified and matched, with up to four randomly selected people without asthma, by age, gender, and practice. Osteoporosis and FF incidence rates were calculated, and Cox regression was performed comparing hazard rates to the general population. We report the impact of age, gender, glucocorticoids, and the risk of specific fractures.ResultsPatients with asthma had a higher risk of osteoporosis (aHR=1.18, 95% CI: 1.13–1.23) and were 12% (aHR=1.12, 95% CI: 1.07–1.16) more likely to sustain FF than the general population. Age modified the effect of asthma on osteoporosis and FF, such that effect to be stronger in younger people (pinteraction<0.0001). Vertebral (aHR=1.40, 95% CI: 1.33–1.48), and forearm-wrist (aHR=1.27, 95% CI: 1.22–1.32) were the sites linked with a larger incidence. A dose-response relationship between oral corticosteroids (OCS) and osteoporosis was observed, whereas the risk of FF increased in those with 6 or more OCS courses per year. Regular use of inhaled corticosteroids (ICS) increased the risk of both bone conditions.ConclusionPatients with asthma are more likely to develop osteoporosis or sustain FF than the general population with a particular concern in younger people and those more frequently using OCS and ICS.
Symptom control in patients with asthma using inhaled corticosteroids/long-acting β2-agonists (fluticasone furoate/vilanterol or budesonide/formoterol) in the US: a retrospective matched cohort study
