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Higher risk of osteoporosis in adult-onset asthma than childhood-onset asthma: from genetic and prospective evidence

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Abstract

Summary

Both COA and AOA have a genetically causal effect on osteoporosis. COA and AOA were independently associated with incident osteoporosis, and the risk was greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications.

Purpose/Introduction

Childhood-onset asthma (COA) differs with adult-onset asthma (AOA) on genetic susceptibility, severity, and co-morbidities. Whether COA or AOA is independently associated with osteoporosis is unexplored. We aimed to determine the effects of COA and AOA on osteoporosis at genetic and individual level.

Methods

We used two-sample Mendelian randomization analysis to explore the causal effects of COA and AOA on osteoporosis. In the UK Biobank cohort, we included 478,289 osteoporosis-free participants at baseline (2006–2010). Participants were classified as non-asthma, COA, and AOA at recruitment. Multivariate Cox regression analysis was used to evaluate the effects of COA, AOA, and multiple asthma medications on incident osteoporosis risk.

Results

COA and AOA were causally related to osteoporosis, with odds ratio of 1.007 (95% confidence interval (CI), 1.0003–1.0132) and 1.012 (95% CI, 1.002–1.023), respectively. Multivariate Cox regression analysis suggested that COA (hazard ratio (HR), 1.46; 95% CI, 1.32–1.61) and AOA (HR, 1.70; 95% CI, 1.61–1.80) were independently associated with incident osteoporosis, and the risk was greatly higher in AOA (HR, 1.51; 95% CI, 1.34–1.70). In addition to corticosteroids, monotherapy with leukotriene modifiers (HR, 1.70; 95% CI, 1.20–2.42), long-acting beta agonists (HR, 1.49; 95% CI, 1.18–1.87), and short-acting beta agonists (HR, 1.72; 95% CI1.01–2.93) were independently associated with a higher risk of osteoporosis.

Conclusions

Both COA and AOA have a genetically causal effect on osteoporosis, and the risk of osteoporosis is greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications.

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Data availability

The underlying data are accessed from the UK Biobank Resource under the application ID 81888, and materials and methods will be made freely available through the UK Biobank as part of this project.

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Acknowledgements

We thank the participants in the UK Biobank for their participation in the research. The study was conducted using the UK Biobank Resource (Application ID: 81888).

Funding

The National Natural Science Foundation of China (No. 82072500, 82002354).

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Author notes

  1. Weizhong Ding, Yong Huang, Guanghui Li and Yimin Dong Contributed equally.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China

    Weizhong Ding, Guanghui Li, Yimin Dong, Minglong Wu, Kehan Song & Feng Li

  2. Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China

    Yong Huang

  3. Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Xiaochen Li

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Correspondence to Kehan Song or Feng Li.

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Weizhong Ding, Yong Huang, Guanghui Li, Yimin Dong, Xiaochen Li, Minglong Wu, Kehan Song, and Feng Li declare that they have no conflict of interest.

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Ding, W., Huang, Y., Li, G. et al. Higher risk of osteoporosis in adult-onset asthma than childhood-onset asthma: from genetic and prospective evidence. Osteoporos Int 35, 659–668 (2024). https://doi.org/10.1007/s00198-023-07004-1

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