The Skeletal Effects of Inhaled Glucocorticoids

Sutter, Stephanie; Stein, Emily

doi:10.1007/s11914-016-0308-1

Cited by 37 publications

(24 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Long-term use of OCS may also induce other adverse effects; for example, it was reported that morbidity rates for patients with severe asthma comorbid with other diseases, such as type-2 diabetes, dyspeptic disorder, and cataract, prescribed with higher OCS dose were significantly higher than those with mild/moderate asthma. Glucocorticoid highly decreases bone formation by inhibiting cell differentiation, and increasing apoptosis might be the mechanism causing such an effect [ 67 ]. Consistent to previous investigations, our study showed that the cumulative doses of OCS and ICS were significantly higher for patients with fracture than those without fracture, indicating the dose-response effects (Tables 5 and 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…It was noted that the prevalence of asthma in patients with fracture was significantly lower than those without fracture, while COPD was more prevalent in patients with fracture than those without fracture. With regard to bronchiectasis, although it was more prevalent in patients with fracture, but not reaching significance, the inconsistency might be caused by a difficulty in differentiating skeletal effects of corticosteroid medications and COPD itself [ 67 ] and symptoms of COPD overlapped with asthma [ 77 , 78 ] or bronchiectasis [ 79 , 80 ] for some patients. The mortality rate of bronchiectasis was reported to be as high as 20.4% and increased to 55% if comorbid with COPD [ 81 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset

Chen

Lin

Wang

et al. 2018

Journal of Healthcare Engineering

View full text Add to dashboard Cite

More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002–2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84–77.00% and an AUC of 0.7495–0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset

Chen

Lin

Wang

et al. 2018

Journal of Healthcare Engineering

View full text Add to dashboard Cite

show abstract

“…None of these subjects, however, were treated with high dosages or with oral glucocorticoids. Because the impact of inhaled glucocorticoids was regarded to be minimal, we did not exclude them from the study. Furthermore, the selection of the mutation‐negative individuals for the control group was based solely on family relations, in order to have groups with similar overall genetic backgrounds, while disregarding age, gender, or menopausal status as inclusion or exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers in WNT1 and PLS3 Osteoporosis: Altered Concentrations of DKK1 and FGF23

Mäkitie

Kämpe

Costantini

et al. 2020

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Recent advancements in genetic research have uncovered new forms of monogenic osteoporosis, expanding our understanding of the molecular pathways regulating bone health. Despite active research, knowledge on the pathomechanisms, disease-specific biomarkers, and optimal treatment in these disorders is still limited. Mutations in WNT1, encoding a WNT/β-catenin pathway ligand WNT1, and PLS3, encoding X chromosomally inherited plastin 3 (PLS3), both result in early-onset osteoporosis with prevalent fractures and disrupted bone metabolism. However, despite marked skeletal pathology, conventional bone markers are usually normal in both diseases. Our study aimed to identify novel bone markers in PLS3 and WNT1 osteoporosis that could offer diagnostic potential and shed light on the mechanisms behind these skeletal pathologies. We measured several parameters of bone metabolism, including serum dickkopf-1 (DKK1), sclerostin, and intact and C-terminal fibroblast growth factor 23 (FGF23) concentrations in 17 WNT1 and 14 PLS3 mutation-positive subjects. Findings were compared with 34 healthy mutation-negative subjects from the same families. Results confirmed normal concentrations of conventional metabolic bone markers in both groups. DKK1 concentrations were significantly elevated in PLS3 mutation-positive subjects compared with WNT1 mutation-positive subjects (p < .001) or the mutationnegative subjects (p = .002). Similar differences were not seen in WNT1 subjects. Sclerostin concentrations did not differ between any groups. Both intact and C-terminal FGF23 were significantly elevated in WNT1 mutation-positive subjects (p = .039 and p = .027, respectively) and normal in PLS3 subjects. Our results indicate a link between PLS3 and DKK1 and WNT1 and FGF23 in bone metabolism. The normal sclerostin and DKK1 levels in patients with impaired WNT signaling suggest another parallel regulatory mechanism. These findings provide novel information on the molecular networks in bone. Extended studies are needed to investigate whether these biomarkers offer diagnostic value or potential as treatment targets in osteoporosis.

show abstract

“…Osteoporosis has been linked with asthma as well, mainly due to chronic corticosteroid therapy ( 55 – 57 ); yet musculoskeletal complications of inhaled corticosteroids are highly debatable ( 55 , 58 ). Lower bone mineral density in adult asthmatic patients using inhaled glucocorticoids compared to untreated controls has been described ( 57 , 59 , 60 ), even though this finding was not uniform ( 61 , 62 ).…”

Section: Metabolic Disorders and Asthmamentioning

confidence: 99%

“…Lower bone mineral density in adult asthmatic patients using inhaled glucocorticoids compared to untreated controls has been described ( 57 , 59 , 60 ), even though this finding was not uniform ( 61 , 62 ). A dose response relationship between use of oral glucocorticoids with risk of fracture in patients and asthma has been extensively validated ( 55 , 63 ).…”

Section: Metabolic Disorders and Asthmamentioning

confidence: 99%

Metabolic Disorders in Chronic Lung Diseases

et al. 2018

View full text Add to dashboard Cite

Chronic lung diseases represent complex diseases with gradually increasing incidence, characterized by significant medical and financial burden for both patients and relatives. Their increasing incidence and complexity render a comprehensive, multidisciplinary, and personalized approach critically important. This approach includes the assessment of comorbid conditions including metabolic dysfunctions. Several lines of evidence show that metabolic comorbidities, including diabetes mellitus, dyslipidemia, osteoporosis, vitamin D deficiency, and thyroid dysfunction have a significant impact on symptoms, quality of life, management, economic burden, and disease mortality. Most recently, novel pathogenetic pathways and potential therapeutic targets have been identified through large-scale studies of metabolites, called metabolomics. This review article aims to summarize the current state of knowledge on the prevalence of metabolic comorbidities in chronic lung diseases, highlight their impact on disease clinical course, delineate mechanistic links, and report future perspectives on the role of metabolites as disease modifiers and therapeutic targets.

show abstract

The Skeletal Effects of Inhaled Glucocorticoids

Cited by 37 publications

References 73 publications

Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset

Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset

Biomarkers in WNT1 and PLS3 Osteoporosis: Altered Concentrations of DKK1 and FGF23

Metabolic Disorders in Chronic Lung Diseases

Contact Info

Product

Resources

About