Allergy Asthma Immunol Res.  2019 May;11(3):343-356. 10.4168/aair.2019.11.3.343.

Trabecular Bone Score Is More Sensitive to Asthma Severity and Glucocorticoid Treatment Than Bone Mineral Density in Asthmatics

• Choi YJ
• Lee HY
• Yoon D
• Kim A
• Shin YS
• Park HS
• Ye YM

• KMID: 2442046
• DOI: http://doi.org/10.4168/aair.2019.11.3.343

Abstract

PURPOSE
In asthmatic patients, treatment with corticosteroids, in addition to conventional risk factors for osteoporosis, may lead to bone loss. Trabecular bone score (TBS) is an indirect new parameter of bone quality. This study aimed to evaluate TBS in asthmatics in comparison to propensity score-matched controls and to investigate correlations between TBS and cumulative systemic and inhaled corticosteroid doses 1 year prior to bone mineral density (BMD) measurement in patients with asthma.
METHODS
In total, 627 patients with asthma and the same number of non-asthmatic controls matched for sex and age were included in this retrospective cohort study. TBS was calculated in the lumbar region, based on 2 dimensional projections of dual-energy X-ray absorptiometry.
RESULTS
Patients with severe asthma exhibited lower vertebral TBS values (1.32 ± 0.1) than those with non-severe asthma (1.36 ± 0.1, P = 0.001), with non-active asthma (1.38 ± 0.1, P < 0.001), and without asthma (1.39 ± 0.1, P < 0.001). No significant differences in BMD were noted among the study groups. TBS was significantly correlated with cumulative systemic and inhaled corticosteroid doses as well as asthma duration, lung function and airway hyper-responsiveness. A generalized linear model revealed that age, severe asthma, and frequency of oral corticosteroid burst were significant predictors for TBS levels.
CONCLUSIONS
TBS can be used as an early indicator of altered bone quality stemming from glucocorticoid therapy or, possibly, more severe asthma.

Keyword

Asthma; trabecular bone score; bone mineral density

MeSH Terms

Absorptiometry, Photon
Adrenal Cortex Hormones
Asthma*
Bone Density*
Cohort Studies
Humans
Linear Models
Lumbosacral Region
Lung
Osteoporosis
Respiratory Hypersensitivity
Retrospective Studies
Risk Factors
Adrenal Cortex Hormones

Figure

• 

  Fig. 1 Scheme of study subject selection. ICD, International Classification of Diseases; ICS, inhaled corticosteroid; LABA, long-acting beta-adrenoceptor agonist; LTRA, leukotriene receptor antagonist; BMD, bone mineral density; SABA, short-acting beta agonists; ER, emergency room; PSM, propensity score matching.

• 

  Fig. 2 (A) TBS and (B) BMD according to age and study grouping. P values were evaluated by generalized linear models adjusting for cumulative systemic steroid dose (g) for 1 year prior to index date. TBS, trabecular bone score; BMD, bone mineral density. *P < 0.05; † P < 0.01 for comparing to TBS levels in patients with severe asthma aged over 65 years old.

• 

  Fig. 3 TBS and BMD according to asthma severity and existence of exacerbation. P values were obtained by generalized linear models controlling with inhaled and systemic corticosteroid doses over the year prior to bone mineral densitometry measurement. Each level of TBS and BMD was compared to non-severe asthma without exacerbation as references. TBS, trabecular bone score; BMD, bone mineral density.

• 

  Fig. 4 TBS and BMD according to ICS dose. P values were obtained by generalized linear models adjusting for age, sex, use of anti-osteoporotic medications and systemic corticosteroid dose over the year prior to measurement of TBS (line) and BMD (bar). Patients without ICS treatment were used as references. TBS, trabecular bone score; BMD, bone mineral density; ICS, inhaled corticosteroid.

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