frequency of osteoporosis in asthmatic patients who receive inhaled corticosteroid
DESCRIPTION
FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID. İlknur Başyiğit, Serap Argun Barış , Haşim Boyacı, Füsun Yıldız Kocaeli University Faculty of Medicine Chest Disease Department. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
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FREQUENCY OF OSTEOPOROSIS IN ASTHMATIC PATIENTS WHO RECEIVE INHALED CORTICOSTEROID
İlknur Başyiğit, Serap Argun Barış, Haşim Boyacı, Füsun Yıldız Kocaeli University Faculty of Medicine Chest Disease Department
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Introduction
Asthma is a chronic inflammatory disease with reversible airway obstruction.
Inflammation causes bronchial smooth muscle
contraction and bronchial hyperreactivity.
Inhaled corticosteroids are the most effective and most frequently used antiinflammatory agents in the treatment of asthma.
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Introduction
Osteoporosis is one of the important side effect of long term systemic corticosteroid treatment.
Pathophysiology of osteoporosis with corticosteroid treatment:
Decrease in new bone synthesis via the suppression of osteoblastic activity
Activation of bone resorption Inhibition of intestinal calcium absorption
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Introduction
It is accepted that systemic side effects of inhaled corticosteroids (ICS) are minimal.
The effect of ICS in bone mineral densitometry is controversial in previous studies.
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Aim
The aim of this study was to determine whether there was a difference in osteoporosis frequency between asthmatic patients who were on ICS treatment and not.
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Methods
The patients who were followed-up in asthma outpatient clinic were included in the study.
Age, gender, disease and ICS treatment duration and dose were recorded.
Medical history and risk factors for osteoporosis were recorded.
Patients who were not received ICS were enrolled as control group.
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Methods
Blood calcium, phosphate, alkaline phosphatase, parathormone and vitamin D levels were analyzed and bone mineral densitometry (BMD) was performed.
DXA (Dual- energy x ray absorptiometry) was used for vertebrae and femur bone mineral densitometry.
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Methods
The results was standardized with t score according to race and gender.
t- score <-2.5 osteoporosis t- score <-1.5/-2.5 osteopenia
Femur and vertebrae BMD findings; normal, osteopenia osteoporosis.
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Methods
Exclusion criteria:
Diagnosis or treatment of osteoporosis before ICS treatment
Use of oral corticosteroids in the previous 3 months
Diagnosis of COPD
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Methods
Use of medication that is known as to effect
bone mineral densitometry such as
-Calcium
-Vitamine D -Calsitonin -Estrogen
- Anticonvulsant- Diuretics
İmmobilization
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Results
44 female, 16 male totally 60 patients were included in the study.
Mean age was 51.7 ± 11 years -In female mean age was 51 ± 10.7 years -In male mean age was 53.5 ± 12.4 years
Duration of disease was 8.4 ± 4.3 years
Mean duration for ICS treatment was 15 months
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Graphic-1: Groups according to inhaled corticosteroid dose
Patients were divided into 3 groups according to their ICS treatment dose;
high dose ICS (n:33), low-moderate dose ICS
(n:12) and non-user (n:15).
0
10
20
30
40
50
60
High dose ICS(n:33)
Low-moderatedose ICS (N:12)
Non-user (n:15)
ICS dose
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Table-1: Demographic characteristics
High dose IKS
Moderate-low dose ICS
Non-user
n 33 12 15
Age, year 50.8 ± 10.4 47.4 ± 10.2 57.0 ± 12.0*
Duration of ICS, month
22.9 ± 14.5 29.0 ± 22.6 0
Vertebra BMD 15 N, 13 OP, 5 OS
2 N, 8 OP, 2 OS
1 N, 8 OP, 6 OS*
Femur BMD 19 N, 11 OP, 3 OS
8 N, 4 OP, 0 OS
7 N, 6 OP, 2 OS
N: Normal, OP: Osteopenia, OS: Osteoporosis
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Results
There was no significant correlation between the duration of ICS and BMD femur, BMD vertebrae findings and t-scores.
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Results
29 patients received budesonide, 16 patients received fluticazone propionate
There was no significant correlation between the pharmacological formulation of ICS and BMD femur, BMD vertebrae findings and t-scores.
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Graphic-2: Asthma severity according to groups
0
5
10
15
20
25
High dose Moderate-low
dose
Non-user
Mild I ntermittantAsthma
Mild PersistantAsthma
Moderate PersistantAsthma
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Table-2: PFT results according to groups
High dose Moderate-low dose
Non-user p
FVC 2.82 ± 0.8 3.49 ± O.87 2.65 ± 0.87 0.04
FVC % predictive
95 ± 12 111 ± 14 90 ± 9 0.005
FEV1 1.97 ± 0.64 2.52 ± 48 1.6 ± 0.7 0.05
FEV1 % predictive
77 ± 12.5 95 ± 15 62 ± 7.7 0.00
FEV1/FVC,%
68.7 ± 8.3 72.6 ± 6.7 59 ± 10 0.02
PEF 4.8 ± 1.33 6.03 ± 1.14 4.87 ± 1.9 0.02
PEF % predictive
74.8 ± 14.7 90 ± 13.6 71.6 ± 14.8 0.007
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Table-3: Biochemical parameters
Minimum Maksimum Mean SD
Calcium 8.5 10.4 9.37 0.426
Phosphate 2.18 4.30 3.48 0.44
Alkaline phosphatase
45 146 85.18 31.94
Parathormone 16 281 60.69 38.57
Vitamin D 6.4 16.28 11.34 6.98
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Results
No difference was found between male and female patients with respect to BMD test results.
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Graphic-3: Vertebrae BMD findings according to gender
0
10
20
30
40
50
60
Normal Osteopenia Osteoporosis
Female
Male
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Graphic-4: Femur BMD findings according to gender
0
10
20
30
40
50
60
70
Normal Osteopenia Osteoporosis
Female
Male
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Table-4: Gender distribution and number of postmenopausal women in groups
High dose ICSn:33 %
Moderate-low dose
ICS n: 12
%
Non- user
n: 15 %
Male 5 15 2 17 9 60
Female 28 85 10 83 6 40
Postmenopausal
14 50 4 40 5 83
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Results
23 of 44 women in the study were in postmenopausal period
While we investigated the effects of menopause in the findings of BMD; it was found that femur BMD findings (p=0.05) and t- scores (p=0.04) were significantly different in postmenopausal women compared to others.
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Results
There was no difference in femur BMD findings and t scores among the groups.
In vertebrae BMD test; there were significantly lower t scores (p=0.01) and more frequent osteoporosis (p=0.01) in patients who were not on ICS treatment.
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Table-5: Osteoporosis and t-score according to groups
FEMUR VERTEBRAE
Osteoporosis t score Osteoporosis t score
High dose ICS
3 (%9) - 0.5 ± 1.3
5 (%15) -0.7 ± 1.6
Moderate-low dose ICS
- (%0) -0.5 ± 0.6
2 (%16) -1.2 ± 1
Non-user 2 (%13) -0.8 ± 1.2 6 (%40)* -1.8 ± 0.8*
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Results
There was a significant correlation between the age and femur and vertebrae BMD findings. (p=0,04)
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Conclusion
It was suggested that osteoporosis in asthmatic patients might not be related to the pharmacological formulation, dose and treatment duration of ICS.
The high osteoporosis frequency in patients who were not on ICS treatment might be explained by the age and postmenopausal changes of these patient population.