ICS are a common therapy for both asthma and COPD. While use of systemic corticosteroids can decrease BMD, the impact of long-term ICS use on BMD is uncertain.
A meta-analysis evaluating the impact of ICS therapy on BMD was performed. We searched MEDLINE and EMBASE databases and consulted with experts to identify published and unpublished literature reporting BMD among adult asthma and COPD patients using ICS and non-ICS using controls. Studies selected for review included at least one-year of follow-up. Two independent reviewers evaluated studies; data from those meeting specified inclusion criteria were abstracted. Random-effects meta-analysis was performed for all outcomes present in at least four included studies.
A total of 266 studies were identified and reviewed; 14 (5.3%) met specified inclusion criteria for the meta-analysis. Sufficient data were available to perform meta-analysis on BMD measures for ICS-using patients; only one measure (lumbar BMD) was available among non-ICS using controls. Using current NAEPP definitions, the majority of studies (12 of 14) included patients receiving moderate to high doses of ICS. Mean changes in lumbar BMD were not significantly different from baseline or from controls (−0.02%) for patients with asthma (+0.13%) and COPD (−0.42%) following 1 to 4 years of treatment. Among ICS users, changes from baseline in femoral neck and major trochanter BMD (−0.17% and +1.46%, respectively) were not statistically significant. Non-significant changes from baseline in lumbar BMD of −0.20%, −0.39%, and −0.73% were observed with fluticasone, budesonide, and beclomethasone, respectively.CONCLUSIONS: Long-term use of ICS in patients with asthma or COPD was not associated with significant changes in BMD.
Treatment with ICS at standard doses in patients with asthma or COPD does not have a clinically meaningful effect on BMD.
M.T. Halpern, GlaxoSmithKline, Grant monies.