Osteoporosis Awareness in Asthma Patients Using Inhaled Corticosteroids: A Cross-Sectional Study

Year 2025, Volume: 15 Issue: 2, 93 - 106, 30.06.2025

Gülcan Öztürk , Berrin Zinnet Eraslan , Serap Diktaş Tahtasakal , Pinar Akpınar , Duygu Silte Karamanlioglu , Feyza Ünlü Özkan , İlknur Aktaş , Sevda Cömert

https://doi.org/10.31832/smj.1624674

Abstract

Objective: The aim of this study was to assess osteoporosis awareness in asthma patients using inhaled corticosteroids (ICS) and to identify the influencing factors.
Materials and Methods: A total of 109 asthma patients using ICS (10 male, 99 female; mean age: 50.30±12.04 years) were included in the cross-sectional study. Demographic data regarding age, gender, education level, marital status, occupation and disease duration of all participants were recorded. General knowledge questions about osteoporosis, diet and exercise were asked. Osteoporosis awareness was assessed using the Osteoporosis Awareness Scale (OAS).
Results: Osteoporosis awareness in asthma patients using ICS were found to be low. Eight of the participants included in the study (7.3%) were aware that they were at risk for osteoporosis, while 101 (92.7%) were unaware. The total OAS score was 51.32±15.70. The sub-score risk factor scores in postmenopausal women were significantly higher than those in premenopausal women (p< 0.05). The exercise, preventive behaviour, risk factor scores, the characteristics of OP scores and total score of participants who had heard of osteoporosis were statistically significantly higher than those who had not heard of it (p<0.05). The proportion of participants who had not heard of osteoporosis and were primary school graduates was significantly higher (68.1%) compared to those who had heard of osteoporosis (38.7%). The sub-score risk factor and preventive behavior scores were significantly higher for participants taking vitamin D compared to those not taking it (p<0.05). Additionally, the total and sub-score characteristics of OP, along with risk factor scores, were significantly higher in participants with a family history of fractures (p<0.05).
Conclusions: Asthma patients using ICS have low levels of osteoporosis awareness. The menopausal status, vitamin D intake, family history of fractures and having heard OP before affects the osteoporosis awareness. In order to reduce the incidence of osteoporosis, morbidity and mortality, patient education programs should be organized especially for asthma patients especially using ICS in the risk group.

Keywords

Asthma , Awareness , Corticosteroids , Osteoporosis

Ethical Statement

Ethical approval for the study was obtained from the Hamidiye University of Health Sciences Scientific Research Ethics Committee (approval number: 24/715).

References

• Loke YK, Gilbert D, Thavarajah M, Blanco P, Wilson AM. Bone mineral density and fracture risk with long-termuse of inhaled corticosteroids in patients with asthma: Systematicre view and meta-analysis. BMJ Open. 2015;5(11):e008554.
• Yanik B, Ayrim A, Ozol D, Koktener A, Gokmen D. Influence of obesity on bone mineral density in postmenopausal asthma patients undergoing treatment with inhaled corticosteroids. Clinics. 2009;64(4):313–318.
• Gershon AS, Guan J, Wang C, Victor JC, To T. Describing and quantifying asthma comorbidity: A population study. PLoS One. 2012;7(5):e34967
• Sutter SA, Stein EM. The skeletal effects of inhaled glucocorticoids. Curr Osteoporos Rep. 2016;14(3):106-113.
• Daugherty J, Lin X, Baxter R, Suruki R, Bradford E. The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis. J Asthma.2018;55(6):651–658.
• Türkiye Endokrinoloji ve Metabolizma Derneği. Osteoporoz ve Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu. 2020. Miki Matbaacılık San. ve Tic. Ltd. Şti.
• Chee C, Sellahewa L, Pappachan JM. Inhaled corticosteroids and bone health. Open Respir Med J. 2014;8:85-92.
• Chalitsios CV, Shaw DE, McKeever TM. Corticosteroidsand bone health in people with asthma: A systematic review and meta-analysis. Respir Med. 2021;181:106374.
• Sidoroff VH, Ylinen MK, Kröger LM, Kröger HP, Korppi MO. Inhaled corticosteroids and bone mineral density at school age: A follow-up study after early childhood wheezing. Pediatr Pulmonol. 2015;50(1):1-7.
• Kong SH, Jo AJ, Park CM, Park KI, Yun JE, Kim JH. Elevated fracture risks in patients using inhaled corticosteroids: A Korean nationwide study. Endocrinol Metab (Seoul). 2025;40(1):82-92.
• Aksu A, Zinnuroğlu M, Karaoğlan B, Akın S, Kutsal YG, Atalay F, et al. Osteoporoz, eğitim durumu farkındalık düzeyi araştırma sonuçları. Turk J Osteoporoz. 2005;11(1):36-40.
• Şahin E, Dilek B, Baydar M, Kösehanoğulları M, Uçku R, Öncel S. Kırk beş yaş ve üzeri hastalarda radius distal uç kırıklarından sonra osteoporoz farkındalığı ve etkileyen faktörler. Türk Fiz Tıp Rehab Derg. 2013;59:52-56.
• Aktürk SO, Meseri R, Özentürk MG. The psychometric property evaluation of the Turkish version of the osteoporosis awareness scale. Turk J Osteoporos. 2021;27(3):151-158.
• Kavak SK, Aktekin L, Kavak EE, Sevingül B, Önoğul M. Osteoporosis awareness and knowledge in postmenopausal breast cancer survivors. Turk J Osteoporos. 2024;30(1):30-36.
• Temel MH, Taşdelen B, Demir S, Ata E. Assessing osteoporosis awareness and knowledge levels of Turkish multiple sclerosis patients: an observational study. Arch Osteoporos. 2024;19(1):67.
• Karagül S, Kartaloğlu IF. The comparison of osteoporosis knowledge and awareness levels of patients with hypothyroidism and hyperthyroidism. Turk J Osteoporos. 2023;29(2):117–123.
• Şen SB, Kaya E, Bilecik NA. Spinal kord yaralanmalı hastalarda osteoporoz bilgi ve farkındalık düzeyi. Turk J Osteoporos. 2022;28(3):188-192.
• Uyanık H, Aksoy YE. Türk kadınlarının osteoporoz farkındalık düzeyleri ve yaşam kalitesini etkileyen faktörlerin belirlenmesi. Selçuk Sağlık Dergisi. 2024;5(1):15–36.
• Saw SM, Hong CY, Lee J, Wong ML, Chan MF, Cheng A, et al. Awareness and health beliefs of women towards osteoporosis. Osteoporos Int. 2003;14(7):595-601.
• El Hage C, Hallit S, Akel M, Dagher E. Osteoporosis awareness and health beliefs among Lebanese women aged 40 years and above. Osteoporos Int. 2019;30(4):771-786.
• Amer M, Noor S, Kashif SM, Nazir SR, Ghazanfar T, Yousaf S. Evaluation of disease related knowledge in patients of osteoporosis: An observational study. Altern Ther Health Med. 2020;27(S1):97-103.
• Magnus JH, Joakimsen RM, Berntsen GK, Tollan A, Søogaard AJ. What do Norwegian women and men know about osteoporosis? Osteoporos Int. 1996;6(1):32-36.
• Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int. 2005;16(2):115-127.
• Karakaş A, Gündüz NE, Özçelik S, Limoncu H, Dilek B, Gülbahar S et. Al. Awareness and knowledge levels of osteoporosis in patients with multiple sclerosis. Turk J Osteoporos. 2022;28(2):131-136.
• Keskin Y, Taşpınar Ö. Evaluation of the quality of life of patients with postmenopausal osteoporosis. Sakarya Med J. 2020;10(2):216-224.
• Wang L, Xu X, Zhang Y, Hao H, Chen L, Su T et al. A model of health education and management for osteoporosis prevention. Exp Ther Med. 2016;12(6):3797-3805.
• Park KS, Yoo JI, Kim HY, Jang S, Park Y, Ha YC. Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly. BMC Public Health. 2017:19;17(1):966.
• Clinician’s guide to prevention and treatment of osteoporosis. Available from: http://www.nof.org. Accessed March 2025.
• Gökalp O, Kaya Ç, Kaya Y. Osteoporosis awareness and effecting factors: A descriptive cross-sectional study. Turk J Osteoporos. 2024;30(3):149-156.
• Aksoy T, Kutluk Ö, Sezer İ. Osteoporosis knowledge and awareness among rheumatoid arthritis patients: A cross-sectional controlled study. Arch Rheumatol. 2024;39:411-418.
• Altın E, Karadeniz B, Türkyön F, Baldan F, Akkaya N, Atalay NŞ et al. The comparison of knowledge level and awareness of osteoporosis between women and men. Turk J Osteoporos. 2014;20(3):98-103.
• McLeod KM, Johnson CS. A systematic review of osteoporosis health beliefs in adult men and women. J Osteoporos. 2011;2011:197454.
• Doheny MO, Sedlak CA, Estok PJ, Zeller RA. Bone density, health beliefs, and osteoporosis preventing behaviors in men. Orthop Nurs. 2011;30(4):266-272.
• Shin HY, Kang HC, Lee K, Park SM. Association between the awareness of osteoporosis and the quality of care for bone health among Korean women with osteoporosis. BMC Musculoskelet Disord. 2014;15:334.
• Zein JG, Erzurum SC. Asthma is different in women. Curr Allergy Asthma Rep. 2015;15(6):28.
• Fujita K, Kasayama S, Hashimoto J, Nagasaka Y, Nakano N, Morimoto Y et al. Inhaled corticosteroids reduce bone mineral density in early postmenopausal but not premenopausal asthmatic women. J Bone Miner Res. 2001;16(4):782-787.
• Liu Y, Liu Y, Huang Y, Le S, Jiang H, Ruan B, et al. The effect of overweight or obesity on osteoporosis: A systematic review and meta-analysis. Clin Nutr. 2023;42(12):2457-2467.
• Silveira EA, Mendonça CR, Delpino FM, Elias Souza GV, Pereira de Souza Rosa L, de Oliveira C, et al. Sedentary behavior, physical inactivity, abdominal obesity and obesity in adults and older adults: A systematic review and meta-analysis. Clin Nutr ESPEN. 2022;50:63-73.
• Kurt EE, Koçak FA, Tuncay F, Erdem HR, Kıranatlıoğlu F. Kırsal bölgede yaşayan risk grubu kadınların osteoporoz bilgi ve farkındalık düzeyi. Turk J Osteoporos. 2015;21(2):63-68.
• Bayındır Çevik A, Pekmezci H, Koçan S. Sağlık eğitimi alan kız öğrencilerinin osteoporoz risk faktörleri ve farkındalıklarının değerlendirilmesi. HSP. 2016;3(1):31-38.
• Biri A, Albayrak S. Onbeş yaş ve üzeri kadınların osteoporoz konusundaki bilgileri. MN-Klinik Bilimler Doktor. 2005;11:444-450.