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FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID

FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID. İlknur Başyiğit, Serap Argun Barış , Haşim Boyacı, Füsun Yıldız Kocaeli University Faculty of Medicine Chest Disease Department. Introduction.

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FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID

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  1. FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID İlknur Başyiğit, Serap Argun Barış, Haşim Boyacı, Füsun Yıldız Kocaeli University Faculty of Medicine Chest Disease Department

  2. Introduction • Asthma is a chronic inflammatory disease with reversible airway obstruction. • Inflammation causes bronchial smooth muscle contraction and bronchial hyperreactivity. • Inhaled corticosteroids are the most effective and most frequently used antiinflammatory agents in the treatment of asthma.

  3. Introduction • Osteoporosis is one of the important side effect of long term systemic corticosteroid treatment. • Pathophysiology of osteoporosis with corticosteroid treatment: • Decrease in new bone synthesis via the suppression of osteoblastic activity • Activation of bone resorption • Inhibition of intestinal calcium absorption

  4. Introduction • It is accepted that systemic side effects of inhaled corticosteroids (ICS) are minimal. • The effect of ICS in bone mineral densitometry is controversial in previous studies.

  5. Aim • The aim of this study was to determine whether there was a difference in osteoporosis frequency between asthmatic patients who were on ICS treatment and not.

  6. Methods • The patients who were followed-up in asthma outpatient clinic were included in the study. • Age, gender, disease and ICS treatment duration and dose were recorded. • Medical history and risk factors for osteoporosis were recorded. • Patients who were not received ICS were enrolled as control group.

  7. Methods • Blood calcium, phosphate, alkaline phosphatase, parathormone and vitamin D levels were analyzed and bone mineral densitometry (BMD) was performed. • DXA (Dual- energy x ray absorptiometry) was used for vertebrae and femur bone mineral densitometry.

  8. Methods • The results was standardized with t score according to race and gender. • t- score <-2.5 osteoporosis • t- score <-1.5/-2.5 osteopenia • Femur and vertebrae BMD findings; • normal, • osteopenia • osteoporosis.

  9. Methods • Exclusion criteria: • Diagnosis or treatment of osteoporosis before ICS treatment • Use of oral corticosteroids in the previous 3 months • Diagnosis of COPD

  10. Methods • Use of medication that is known as to effect bone mineral densitometry such as -Calcium -Vitamine D -Calsitonin -Estrogen - Anticonvulsant - Diuretics • İmmobilization

  11. Results • 44 female, 16 male totally 60 patients were included in the study. • Mean age was 51.7±11 years -In female mean age was 51 ± 10.7 years -In male mean age was 53.5 ± 12.4 years • Duration of disease was 8.4±4.3 years • Mean duration for ICS treatment was 15 months

  12. Graphic-1: Groups according to inhaled corticosteroid dose • Patients were divided into 3 groups according to their ICS treatment dose; • high dose ICS (n:33), • low-moderate dose ICS (n:12) and • non-user (n:15).

  13. Table-1: Demographic characteristics N: Normal, OP: Osteopenia, OS: Osteoporosis

  14. Results • There was no significant correlation between the duration of ICS and BMD femur, BMD vertebrae findings and t-scores.

  15. Results • 29 patients received budesonide, • 16 patients received fluticazone propionate • There was no significant correlation between the pharmacological formulation of ICS and BMD femur, BMD vertebrae findings and t-scores.

  16. Graphic-2:Asthma severity according to groups

  17. Table-2: PFT results according to groups

  18. Table-3:Biochemical parameters

  19. Results • No difference was found between male and female patients with respect to BMD test results.

  20. Graphic-3:Vertebrae BMD findings according to gender

  21. Graphic-4:Femur BMD findings according to gender

  22. Table-4:Gender distribution and number of postmenopausal women in groups

  23. Results • 23 of 44 women in the study were in postmenopausal period • While we investigated the effects of menopause in the findings of BMD; it was found that femur BMD findings (p=0.05) and t- scores (p=0.04) were significantly different in postmenopausal women compared to others.

  24. Results • There was no difference in femur BMD findings and t scores among the groups. • In vertebrae BMD test; there were significantly lower t scores (p=0.01) and more frequent osteoporosis (p=0.01) in patients who were not on ICS treatment.

  25. Table-5: Osteoporosis and t-score according to groups

  26. Results • There was a significant correlation between the age and femur and vertebrae BMD findings. (p=0,04)

  27. Conclusion • It was suggested that osteoporosis in asthmatic patients might not be related to the pharmacological formulation, dose and treatment duration of ICS. • The high osteoporosis frequency in patients who were not on ICS treatment might be explained by the age and postmenopausal changes of these patient population.

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