Impact of Inhaled Corticosteroids on Osteoporosis in Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review
Bibliographic record
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 elderly and female patients. The methodological quality of studies varied, with most demonstrating low to moderate risk of bias. This review highlights the complex relationship between ICS use and bone health in COPD patients, emphasizing the importance of individualized treatment approaches. While ICS remain essential for COPD management, clinicians should consider bone-protective strategies in high-risk patients, particularly those on long-term or high-dose regimens. Future research should standardize exposure and outcome definitions to facilitate more robust quantitative synthesis.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.009 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".