Steroid Pills or Inhalers for Asthma May Increase Risk of Brittle Bones and Fractures

Inhaled (ICS) and oral (OCS) steroids are used widely by asthma patients; however, there is a need to elucidate the risk of brittle bones (osteoporosis) and increasing susceptibility for broken bones (fragility fracture (FF)) due to these steroids to treat asthma.

A new study published in the journal Thorax, BMJ implicates that the increasing use of steroid inhalers and tablets to treat asthma or to control flare-ups is presumed to be associated with the elevated risk of osteoporosis and fragility fractures. Study reveals dose response relationship, stating, “higher the cumulative dose, and the longer the period of treatment, the greater these risks seem to be”.

Asthma is a breathing condition predisposed after the narrowing and swelling of airways, affecting over 334 million people around the globe. It is accompanied by inflammation resulting in mucus production in airways.

Recent scientific reports elucidating on the significance of the steroid therapeutics and treatment options on asthma is lacking. Moreover, steroid inhalers and tablets are extensively used to control the inflammation by clearing out the mucus production in airways and improve breathing. As per international guidelines, it is recommended to follow a stepwise approach to treat the condition and it is advised to prescribe optimum dose of steroid inhalers and tables to treat moderate to severe asthma with controlled flare-ups of severe asthma.

Source: CDC

Since the previous data is lacking and inconclusive, researchers in the current study wished to investigate the potential consequences of using steroids on health of bones in case of asthma.  Therefore, they devised a study to check whether independent effect of dose, number of courses, and steroid type may help them to understand better.

It is particularly important to find the potential link because international guidance has shifted their recommendation towards greater use of inhaled steroids for moderately severe asthma while the use of steroid tablets has also increased.

Source: NIH

Researchers conducted two nested case-control studies, retrieving anonymous health data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. They recruited over 15.4 million patients from 738 doctors’ surgeries across the UK which is believed equivalent to 7% of the UK population.

Between the April 2004 and December 2017, the data was used to identify diagnosed with asthma and had either osteoporosis or fragility fractures. Moreover, patients were also checked whether they were given at least one dose of bisphosphonates – a type of drug used to control the loss of bone density and stave off osteoporosis — and bone strengthening vitamin D and calcium supplements.

They further used the number of prescriptions filled to determine the amount and duration of steroid treatment for the 12 months which lead up to a diagnosis of osteoporosis or fragility fracture.

The detailed analysis showed a clear relationship between both cumulative dose as well as the number of courses of inhaled and steroid tablets with the risk of osteoporosis and fragility fractures. It was found that at least 2-3 prescriptions of steroid tablets in the preceding 12 months were associated with the larger odds of osteoporosis. Therefore, it is recommended to prescribe the steroid administration at the lowest possible level to maintain asthma.

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