Long-term use of inhaled glucocorticoids in patients with stable chronic obstructive pulmonary disease and risk of bone fractures: a narrative review of the literature
| Autor: | Giuseppe Girbino, Paolo Ruggeri, Laura Salvi, Fabio Arpinelli, Gaetano Caramori |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors fracture risk Osteoporosis Population Mometasone furoate Review Placebo Risk Assessment Fluticasone propionate Drug Administration Schedule law.invention 03 medical and health sciences Pulmonary Disease Chronic Obstructive 0302 clinical medicine Randomized controlled trial law Adrenal Cortex Hormones Bone Density Risk Factors Internal medicine Administration Inhalation Medicine COPD Humans 030212 general & internal medicine education Lung Aged Randomized Controlled Trials as Topic education.field_of_study business.industry inhaled corticosteroids osteoporosis Incidence General Medicine Bone fracture Middle Aged medicine.disease Treatment Outcome 030228 respiratory system Female business Osteoporotic Fractures medicine.drug |
| Zdroj: | International Journal of Chronic Obstructive Pulmonary Disease |
| ISSN: | 1178-2005 1176-9106 |
| Popis: | Patients with chronic obstructive pulmonary disease (COPD) demonstrate a greater osteoporosis prevalence than the general population. This osteoporosis risk may be enhanced by treatment with inhaled corticosteroids (ICSs), which are recommended for COPD management when combined with long-acting bronchodilators, but may also be associated with reduced bone mineral density (BMD). We conducted a narrative literature review reporting results of randomized controlled trials (RCTs) of an ICS versus placebo over a treatment period of at least 12 months, with the aim of providing further insight into the link between bone fractures and ICS therapy. As of 16 October 2017, we identified 17 RCTs for inclusion. The ICSs studied were budesonide (six studies), fluticasone propionate (five studies), mometasone furoate (three studies), beclomethasone dipropionate, triamcinolone acetonide, and fluticasone furoate (one each). We found no difference in the number of bone fractures among patients receiving ICSs versus placebo across the six identified RCTs reporting fracture data. BMD data were available for subsets of patients in few studies, and baseline BMD data were rare; where these data were given, they were reported for treatment groups without stratification for factors known to affect BMD. Risk factors for reduced BMD and fractures, such as smoking and physical activity, were also often not reported. Furthermore, a standardized definition of the term “fracture” was not employed across these studies. The exact relationship between long-term ICS use and bone fracture incidence in patients with stable COPD remains unclear in light of our review. We have, however, identified several limiting factors in existing studies that may form the basis of future RCTs designed specifically to explore this relationship. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|