Wang Chun Kwok, Chung Ki Tsui, Sze Him Isaac Leung, Shuk Man Ngai, David Chi Leung Lam, Mary Sau Man Ip, James Chung Man Ho
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High-, medium- and low-dose ICS were defined according to the Global Initiative for Asthma (GINA) step definition.</p>\n </section>\n \n <section>\n \n <h3> Data sources</h3>\n \n <p>Cochrane, EMBASE, Ovid, PubMed and Web of Science were systematically searched until 8 December 2023.</p>\n </section>\n \n <section>\n \n <h3> Data extraction</h3>\n \n <p>Osteoporosis or fracture under ICS therapy was chosen as the primary efficacy outcome. Three reviewers were involved independently in the extraction process. The risk of bias of the included studies was evaluated by using different assessment tools.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-one RCTs and eight observational studies were included. High-dose ICS was associated with increased risks of osteoporosis or fracture in RCTs with RR of 1.14 (95% CI = 1.03–1.28), observational studies with healthy controls 1.14 (95% CI = 1.05–1.24) and observational studies without healthy controls 1.10 (95% CI = 1.01–1.21). High-dose ICS was associated with increased risks in fracture in RCTs with RR of 1.12 (95% CI = 1.03–1.23), observational studies with health controls 1.15 (95% CI = 1.05–1.25) and observational studies without healthy controls 1.13 (95% CI = 1.03–1.24). Medium- and low-dose ICS were not associated with osteoporosis or fracture.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>High-dose, but not medium- and low-dose, ICS use in COPD is associated with risks of osteoporosis or fractures.</p>\n </section>\n </div>","PeriodicalId":55247,"journal":{"name":"Clinical Respiratory Journal","volume":"19 5","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/crj.70086","citationCount":"0","resultStr":"{\"title\":\"Dose of Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease and Risks of Osteoporosis or Fracture—A Systematic Review and Meta-Analysis\",\"authors\":\"Wang Chun Kwok, Chung Ki Tsui, Sze Him Isaac Leung, Shuk Man Ngai, David Chi Leung Lam, Mary Sau Man Ip, James Chung Man Ho\",\"doi\":\"10.1111/crj.70086\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Inhaled corticosteroid (ICS) is a major pharmacotherapy for chronic obstructive pulmonary disease (COPD), which is associated with various adverse effects. 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引用次数: 0
摘要
背景：吸入皮质类固醇（ICS）是慢性阻塞性肺疾病（COPD）的主要药物治疗方法，但存在多种不良反应。对于慢性阻塞性肺病患者使用ICS是否与骨质疏松或骨折有关存在争议。目的：我们进行了一项系统回顾和荟萃分析，以评估不同剂量的ICS对骨质疏松或骨折的风险。根据全球哮喘倡议（GINA）分级定义高、中、低剂量ICS。系统检索数据来源为Cochrane、EMBASE、Ovid、PubMed和Web of Science，检索截止日期为2023年12月8日。选择ICS治疗下的骨质疏松或骨折作为主要疗效终点。三名审稿人独立参与了提取过程。采用不同的评估工具对纳入研究的偏倚风险进行评估。结果纳入21项随机对照试验和8项观察性研究。在随机对照试验中，高剂量ICS与骨质疏松或骨折风险增加相关，RR为1.14 (95% CI = 1.03-1.28)，健康对照观察性研究为1.14 (95% CI = 1.05-1.24)，无健康对照观察性研究为1.10 （95% CI = 1.01-1.21）。在随机对照试验中，高剂量ICS与骨折风险增加相关，RR为1.12 (95% CI = 1.03-1.23)，健康对照观察性研究为1.15 (95% CI = 1.05-1.25)，无健康对照观察性研究为1.13 （95% CI = 1.03-1.24）。中、低剂量ICS与骨质疏松或骨折无关。结论慢性阻塞性肺病患者使用高剂量而非中、低剂量ICS与骨质疏松或骨折风险相关。
Dose of Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease and Risks of Osteoporosis or Fracture—A Systematic Review and Meta-Analysis
Background
Inhaled corticosteroid (ICS) is a major pharmacotherapy for chronic obstructive pulmonary disease (COPD), which is associated with various adverse effects. Controversies exist in whether ICS use in COPD is associated with osteoporosis or fracture.
Objective
We performed a systematic review and meta-analysis to assess the risks of osteoporosis or fracture at different dosing levels of ICS. High-, medium- and low-dose ICS were defined according to the Global Initiative for Asthma (GINA) step definition.
Data sources
Cochrane, EMBASE, Ovid, PubMed and Web of Science were systematically searched until 8 December 2023.
Data extraction
Osteoporosis or fracture under ICS therapy was chosen as the primary efficacy outcome. Three reviewers were involved independently in the extraction process. The risk of bias of the included studies was evaluated by using different assessment tools.
Results
Twenty-one RCTs and eight observational studies were included. High-dose ICS was associated with increased risks of osteoporosis or fracture in RCTs with RR of 1.14 (95% CI = 1.03–1.28), observational studies with healthy controls 1.14 (95% CI = 1.05–1.24) and observational studies without healthy controls 1.10 (95% CI = 1.01–1.21). High-dose ICS was associated with increased risks in fracture in RCTs with RR of 1.12 (95% CI = 1.03–1.23), observational studies with health controls 1.15 (95% CI = 1.05–1.25) and observational studies without healthy controls 1.13 (95% CI = 1.03–1.24). Medium- and low-dose ICS were not associated with osteoporosis or fracture.
Conclusion
High-dose, but not medium- and low-dose, ICS use in COPD is associated with risks of osteoporosis or fractures.
期刊介绍：
Overview
Effective with the 2016 volume, this journal will be published in an online-only format.
Aims and Scope
The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic.
We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including:
Asthma
Allergy
COPD
Non-invasive ventilation
Sleep related breathing disorders
Interstitial lung diseases
Lung cancer
Clinical genetics
Rhinitis
Airway and lung infection
Epidemiology
Pediatrics
CRJ provides a fast-track service for selected Phase II and Phase III trial studies.
Keywords
Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease,
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Journal Citation Reports/Science Edition (Clarivate Analytics)
MEDLINE/PubMed (NLM)
ProQuest Central (ProQuest)
Science Citation Index Expanded (Clarivate Analytics)
SCOPUS (Elsevier)
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