Impact of Inhaled Corticosteroids on Osteoporosis in Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review
Abstract
Inhaled corticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD) management, but their long-term use has been associated with potential adverse effects on bone health, including osteoporosis and fractures. This systematic review aimed to evaluate the impact of ICS on osteoporosis and fracture risk in COPD patients by synthesizing evidence from observational and clinical studies. A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, Embase, and the Cochrane Library, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were screened for eligibility based on predefined inclusion criteria, and data were extracted using a standardized form. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias in included studies. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was performed, focusing on key themes such as dose-response relationships, fracture risk, and the influence of ICS duration. Eleven studies were included, revealing mixed findings on the association between ICS use and bone health outcomes. While some studies reported a dose-dependent increase in osteoporosis incidence and fracture risk, others found no significant association or even protective effects in specific subgroups. High-dose and long-term ICS use were consistently linked to greater risks, particularly in vulnerable populations such as…
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