Ali Erol, Feridun Gürlek , Fatih Alp , Sümeyye Yaylacı , Enes Kocaman , Orkun- -Terzi , Şule Bilgin Kızıltaş , Mehmet Karaçalı , Neslihan Baykara Erol , Muhammed Fatih Şahin , Aydın Dursun

Consideration of Osteoporosis Risk in Selecting Inhaled Corticosteroids for Chronic Obstructive Pulmonary Disease Patients: Budesonide vs Fluticasone?

Introduction

Consideration of osteoporosis risk in selecting inhaled corticosteroids for chronic obstructive pulmonary disease patients: budesonide vs fluticasone?. Investigate osteoporosis risk in COPD patients using inhaled corticosteroids (ICS). Compare Budesonide vs Fluticasone, finding no elevated risk with either ICS.

Abstract

Objective: The use of medium and low-dose inhaled corticosteroids (ICS) did not increase the risk of osteoporosis in individuals with chronic obstructive pulmonary disease (COPD). The goal is to look at the risk of osteoporosis that comes with Budesonide and Fluticasone when choosing ICS for people with COPD, since this group of people is more likely to get osteoporosis. Methods: Patients with Stage E COPD who were on ICS and came to a tertiary healthcare facility between January 2024 and January 2025 were included. There were three groups in the trial: people with COPD who were taking inhaled budesonide, those who were on fluticasone, and a control group. Results: The study comprised 122 participants: 16 COPD patients utilizing inhaled fluticasone, 16 COPD patients utilizing inhaled budesonide, and 90 individuals in the control group. The mean age of the study participants was 72.79 years; the mean age of the fluticasone group was 74.69 years, the mean age of the budesonide group was 73.19 years, and the mean age of the control group was 72.38 years. The groups exhibit no significant difference for osteoporosis (p>0.05). No significant difference was seen between the groups for the duration and intensity of ICS use (p>0.05). Conclusion: In individuals with COPD, the administration of budesonide and fluticasone as inhaled corticosteroid options has not elevated the risk of osteoporosis.

Review

This study addresses a clinically relevant question regarding the differential risk of osteoporosis between budesonide and fluticasone in patients with Stage E Chronic Obstructive Pulmonary Disease (COPD), a population already at heightened risk for bone demineralization. The researchers aimed to determine if either specific inhaled corticosteroid (ICS) option elevated the risk of osteoporosis. The study included 122 participants from a tertiary healthcare facility, comprising 16 patients on fluticasone, 16 on budesonide, and a control group of 90 individuals. After observing no significant differences in mean age, duration, or intensity of ICS use between the groups, the study concluded that neither budesonide nor fluticasone administration elevated the risk of osteoporosis. While the research question is important for guiding therapeutic choices, the methodological details provided in the abstract raise several concerns that significantly limit the interpretability and generalizability of the findings. The most prominent limitation is the extremely small sample size for the active treatment groups (n=16 for each ICS), which is likely underpowered to detect a statistically significant difference in a complex, multifactorial condition like osteoporosis, especially considering its often slow progression. Furthermore, the abstract lacks crucial details regarding the definition and assessment of "osteoporosis," such as whether it was based on bone mineral density (BMD) measurements (e.g., DEXA), fracture history, or other diagnostic criteria. The composition of the control group is also ambiguously described; it is unclear if these individuals were also COPD patients not on ICS, or a general population control, which impacts the validity of the comparison. Consequently, the conclusion that budesonide and fluticasone "have not elevated the risk of osteoporosis" should be interpreted with extreme caution. The study's limited power and lack of detailed methodological information, particularly concerning the assessment of the primary outcome and the inclusion of critical confounders (such as baseline BMD, sex distribution, or other lifestyle factors), mean it cannot definitively rule out a potential difference or long-term effect. Future research in this area would benefit from a significantly larger, adequately powered, longitudinal study design that includes comprehensive baseline data, standardized assessment of bone health outcomes, and accounts for a broader range of known osteoporosis risk factors in this vulnerable patient population.

Full Text

Comments

You need to be logged in to post a comment.