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Osteoporosis in the at-risk asthmatic

机译：高危哮喘中的骨质疏松症

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The effect of inhaled glucocorticosteroids (ICS) on bone metabolism and subsequent osteoporosis is controversial. Explanations for this controversy include various study designs, duration of use, outcome measures, and population demographics of research studies with intranasal or inhalational ICS. Patients with poorly controlled asthma are at greatest risk of osteoporosis because they are commonly treated with intermittent or continuous systemic corticosteroids (SCS) or high-dose ICS. A 45-year-old Caucasian woman presents with moderate-to-severe asthma with frequent albuterol use and nighttime awakenings at least once weekly. She is on fluticasone/salmeterol 500/50 μg one inhalation twice daily and montelukast 10 mg/day. She requires prednisone 15 mg three times per day for 5 days up to three times a year. Is this patient at greater risk of osteopenia, characterized by a T-score between -1.0 and -2.5, and subsequent osteoporosis and an increased risk of fractures? If she has osteopenia, should she be treated with a bisphosphonate? The risk of osteoporosis and fracture increases significantly with frequent administration of SCS, and patients on such medications should undergo preventative measures and treatment. This study discuses factors that contribute to an increased risk of osteoporosis/osteopenia in patients with asthma and suggests recommendations based on the current literature.
机译：吸入糖皮质激素（ICS）对骨骼代谢和随后的骨质疏松的影响是有争议的。对此争议的解释包括鼻内或吸入ICS的各种研究设计，使用时间，结局指标以及研究人群总数。哮喘控制不佳的患者发生骨质疏松症的风险最高，因为他们通常接受间歇性或连续性全身性皮质类固醇（SCS）或大剂量ICS治疗。一名45岁的白种女人每周至少一次出现中度至重度哮喘，频繁使用沙丁胺醇和夜间醒来。她每天两次吸入氟替卡松/沙美特罗500/50μg，孟鲁司特每天10 mg。她需要泼尼松15毫克，每天3次，连续5天，每年最多3次。该患者是否患有骨质疏松症的风险更高，其特征是T评分在-1.0至-2.5之间，进而导致骨质疏松症和骨折风险增加？如果她患有骨质减少症，是否应该接受双膦酸盐治疗？频繁服用SCS会导致骨质疏松症和骨折的风险显着增加，使用此类药物的患者应接受预防措施和治疗。这项研究探讨了导致哮喘患者骨质疏松/骨减少症风险增加的因素，并根据当前文献提出了建议。

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