吸入糖皮质激素治疗对COPD患者的骨密度及骨折风险的影响
|
摘要
目的观察吸入糖皮质激素治疗对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)患者的骨密度及骨折风险的影响。方法 122例COPD患者,70例吸入糖皮质激素的当前使用者和52例从未接受过糖皮质激素治疗的患者,进行了骨密度(bone mineral density,BMD)和身体成分评估,并接受了椎体骨折评估(verterbral fracture assessment,VFA)。考虑用于分析的骨病的风险因素是年龄、性别、吸入糖皮质激素使用、体质量指数(body mass index,BMI)、肌肉质量指数(muscle mass index,MMI)和慢性阻塞性肺病全球倡议(GOLD)类别。同时还使用了针对汉族人群的骨折风险评估工具(FRAX)计算工具。结果这些组间在性别、BMI、MMI、GOLD等级、BMD T评分和Z评分的最低值,骨质疏松症的患病率或年龄的低BMD方面没有差异(P>0.05)。在使用吸入糖皮质激素的14例患者中通过VFA鉴定椎骨骨折,并且在没有接受糖皮质激素的患者中通过VFA鉴定椎体骨折(P<0.05)。MMI与骨质疏松症之间存在关联的趋势(P<0.05),并且根据通过GOLD评分评估的COPD严重性,BMD Z评分逐渐降低。椎体骨折与骨质疏松症(P>0.05)或低MMI(P>0.05)无关。FRAX没有估计骨折风险。结论吸入糖皮质激素可导致骨密度降低,但是骨折风险未发现增加。
Objective To explore the effect of inhaled corticosteroids on bone mineral density, bone metabolism, and fracture risk in patients with chronic obstructive pulmonary disease(COPD). Methods A total of 122 COPD patients, 70 current users of inhaled glucocorticoids and 52 who had never received glucocorticoids, were evaluated for bone mineral density(BMD), body composition, and vertebral fracture assessment(VFA). The risk factors for bone diseases considered for analysis were age, gender, inhaled glucocorticoids use, body mass index(BMI), muscle mass index(MMI), and the Global Initiative for Chronic Obstructive Lung Disease(GOLD) category. The Fracture Risk Assessment Tool(FRAX) for the Han nationality was also employed. ResultsGender, BMI, MMI, GOLD class, the lowest values of the BMD T-score and Z-score, prevalence of osteoporosis, and low BMD for age were not different between the groups(P>0.05). Vertebral fractures were identified via VFA in 14 patients using inhaled corticosteroids and in none of those not receiving glucocorticoids(P<0.05). There was a trend for an association between MMI and osteoporosis(P<0.05) and for a progressive decrease in BMD Z-score according to the COPD severity assessed via the GOLD score(P>0.05), Vertebral fractures were not associated with osteoporosis(P>0.05) or low MMI(P>0.05). The fracture risk was not estimated by FRAX. Conclusion Inhaled corticosteroids causes a decrease in BMD, but no increase in fracture risk.
Objective To explore the effect of inhaled corticosteroids on bone mineral density, bone metabolism, and fracture risk in patients with chronic obstructive pulmonary disease(COPD). Methods A total of 122 COPD patients, 70 current users of inhaled glucocorticoids and 52 who had never received glucocorticoids, were evaluated for bone mineral density(BMD), body composition, and vertebral fracture assessment(VFA). The risk factors for bone diseases considered for analysis were age, gender, inhaled glucocorticoids use, body mass index(BMI), muscle mass index(MMI), and the Global Initiative for Chronic Obstructive Lung Disease(GOLD) category. The Fracture Risk Assessment Tool(FRAX) for the Han nationality was also employed. ResultsGender, BMI, MMI, GOLD class, the lowest values of the BMD T-score and Z-score, prevalence of osteoporosis, and low BMD for age were not different between the groups(P>0.05). Vertebral fractures were identified via VFA in 14 patients using inhaled corticosteroids and in none of those not receiving glucocorticoids(P<0.05). There was a trend for an association between MMI and osteoporosis(P<0.05) and for a progressive decrease in BMD Z-score according to the COPD severity assessed via the GOLD score(P>0.05), Vertebral fractures were not associated with osteoporosis(P>0.05) or low MMI(P>0.05). The fracture risk was not estimated by FRAX. Conclusion Inhaled corticosteroids causes a decrease in BMD, but no increase in fracture risk.
引文
[1] Vestbo J,Hurd S,Agustí A,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J].Am J Respir Crit Care Med,2013,187(4):347-365.
[2] Gan W,Man S,Senthilselvan A,et al.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a meta-analysis [J].Thorax,2004,59(7):574-580.
[3] Watanabe R,Tanaka T,Aita K,et al.Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function[J].J Bone Miner Metab,2015,33(4):392-400.
[4] Cosman F,de Beur S,LeBoff M,et al.Clinician's Guide to Prevention and Treatment of Osteoporosis[J].Osteoporos Int,2014,25(10):2359-2381.
[5] Wilkie M,Finch S,Schembri S.Inhaled corticosteroids for chronic obstructive pulmonary disease--the shifting treatment paradigm[J].COPD,2015,12(5):582-590.
[6] Siris ES,Miller PD,Barrettconnor E,et al.Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women:results from the National Osteoporosis Risk Assessment[J].JAMA,2001,286(22):2815-2822.
[7] Canalis E,Mazziotti G,Giustina A,et al.Glucocorticoid-induced osteoporosis:pathophysiology and therapy[J].Osteoporos Int,2007,18(10):1319-1328.
[8] Kanis JA,Johnell O,Oden A,et al.Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds[J].Osteoporos Int,2001,12(12):989-995.
[9] Craig C,Marshall A,Sj?str?m M,et al.International physical activity questionnaire:12-country reliability and validity[J].Med Sci Sports Exerc,2003,35(8):1381-1395.
[10] Baim S,Leonard MB,Bianchi ML,et al.Official positions of the international society for clinical densitometry and executive summary of the 2007 ISCD pediatric position development conference[J].J Clin Densitom,2006,11(1):4-14.
[11] Cruz-Jentoft A,Baeyens J,Bauer J,et al.Sarcopenia:European consensus on definition and diagnosis:report of the European working group on sarcopenia in older people[J].Age Ageing,2010,39(4):412-423.
[12] Iqbal F,Michaelson J,Thaler L,et al.Declining bone mass in men with chronic pulmonary disease:contribution of glucocorticoid treatment,body mass index,and gonadal function[J].Chest,1999,116(6):1616-1624.
[13] Jones A,Fay J,Burr M,et al.Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2002(1):CD003537.
[14] Pauwels R,L?fdahl C,Laitinen L,et al.Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking.European Respiratory Society Study on Chronic Obstructive Pulmonary Disease [J].N Engl J Med,1999,340(25):1948-1953.
[15] de Vries F,van Staa T,Bracke M,et al.Severity of obstructive airway disease and risk of osteoporotic fracture[J].Eur Respir J,2005,25(5):879-884.
[16] Mathioudakis A,Amanetopoulou S,Gialmanidis I,et al.Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients:aggravating or beneficial?[J].Respirology,2013,18(1):147-153.
[17] Elmst?hl S,Ekstr?m H,Johnell O,et al.No association between inhaled corticosteroids and whole body DXA in postmenopausal women[J].Pharmacoepidemiol Drug Saf,2006,15(7):527-535.
[18] Loke Y,Cavallazzi R,Singh S.Risk of fractures with inhaled corticosteroids in COPD:systematic review and meta-analysis of randomised controlled trials and observational studies [J].Thorax,2011,66(8):699-708.
[2] Gan W,Man S,Senthilselvan A,et al.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a meta-analysis [J].Thorax,2004,59(7):574-580.
[3] Watanabe R,Tanaka T,Aita K,et al.Osteoporosis is highly prevalent in Japanese males with chronic obstructive pulmonary disease and is associated with deteriorated pulmonary function[J].J Bone Miner Metab,2015,33(4):392-400.
[4] Cosman F,de Beur S,LeBoff M,et al.Clinician's Guide to Prevention and Treatment of Osteoporosis[J].Osteoporos Int,2014,25(10):2359-2381.
[5] Wilkie M,Finch S,Schembri S.Inhaled corticosteroids for chronic obstructive pulmonary disease--the shifting treatment paradigm[J].COPD,2015,12(5):582-590.
[6] Siris ES,Miller PD,Barrettconnor E,et al.Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women:results from the National Osteoporosis Risk Assessment[J].JAMA,2001,286(22):2815-2822.
[7] Canalis E,Mazziotti G,Giustina A,et al.Glucocorticoid-induced osteoporosis:pathophysiology and therapy[J].Osteoporos Int,2007,18(10):1319-1328.
[8] Kanis JA,Johnell O,Oden A,et al.Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds[J].Osteoporos Int,2001,12(12):989-995.
[9] Craig C,Marshall A,Sj?str?m M,et al.International physical activity questionnaire:12-country reliability and validity[J].Med Sci Sports Exerc,2003,35(8):1381-1395.
[10] Baim S,Leonard MB,Bianchi ML,et al.Official positions of the international society for clinical densitometry and executive summary of the 2007 ISCD pediatric position development conference[J].J Clin Densitom,2006,11(1):4-14.
[11] Cruz-Jentoft A,Baeyens J,Bauer J,et al.Sarcopenia:European consensus on definition and diagnosis:report of the European working group on sarcopenia in older people[J].Age Ageing,2010,39(4):412-423.
[12] Iqbal F,Michaelson J,Thaler L,et al.Declining bone mass in men with chronic pulmonary disease:contribution of glucocorticoid treatment,body mass index,and gonadal function[J].Chest,1999,116(6):1616-1624.
[13] Jones A,Fay J,Burr M,et al.Inhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2002(1):CD003537.
[14] Pauwels R,L?fdahl C,Laitinen L,et al.Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking.European Respiratory Society Study on Chronic Obstructive Pulmonary Disease [J].N Engl J Med,1999,340(25):1948-1953.
[15] de Vries F,van Staa T,Bracke M,et al.Severity of obstructive airway disease and risk of osteoporotic fracture[J].Eur Respir J,2005,25(5):879-884.
[16] Mathioudakis A,Amanetopoulou S,Gialmanidis I,et al.Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients:aggravating or beneficial?[J].Respirology,2013,18(1):147-153.
[17] Elmst?hl S,Ekstr?m H,Johnell O,et al.No association between inhaled corticosteroids and whole body DXA in postmenopausal women[J].Pharmacoepidemiol Drug Saf,2006,15(7):527-535.
[18] Loke Y,Cavallazzi R,Singh S.Risk of fractures with inhaled corticosteroids in COPD:systematic review and meta-analysis of randomised controlled trials and observational studies [J].Thorax,2011,66(8):699-708.