Advertisement

Long-Term Therapy with Corticosteroids in Nasal Polyposis: A Bone Metabolism Assessment

  • M. Gelardi
  • F. Barbara
  • I. Covelli
  • M. A. Damiani
  • F. Plantone
  • A. Notarnicola
  • B. Moretti
  • N. Quaranta
  • G. CiprandiEmail author
Original Article

Abstract

Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the “Gold Standard” treatment for RSCwNP. The present study aimed to evaluate the side effects of prednisone in a group of patients with RSCwNP treated with long-term CS. In particular, attention was focused on bone disorders (osteopenia and osteoporosis) and prospective fracture risk increase. Forty patients (26 females, mean age 55.70 ± 14.03 years) affected by RSCwNP have been enrolled. Control group included 40 healthy subjects (17 females, mean age 56.37 ± 13.03 years). Nasal endoscopy, skin prick tests, nasal cytology, and bone densitometry were evaluated in all subjects. The likelihood of impaired bone metabolism (osteopenia or osteoporosis) was superimposable in both groups. Within RSCwNP group, no parameter was statistically significant in predicting a metabolism alteration.

Keywords

Chronic rhinosinusitis Nose-sinus polyposis Corticosteroids Densitometry Osteoporosis 

References

  1. 1.
    Fokkens WJ, Lund VJ et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23:1–298Google Scholar
  2. 2.
    Johansson L, Akerlund A et al (2003) Prevalence of nasal polyps in adults: the Skovdepopulation-based study. Ann Otol Rhinol Laryngol. 112:625–629CrossRefGoogle Scholar
  3. 3.
    Larsen K, Tos M et al (2002) The estimated incidence of symptomatic nasal polyps. Acta Otolaryngol 122(2):179–182CrossRefGoogle Scholar
  4. 4.
    DeMarcantonio MA, Han JK (2011) Nasal polyps: pathogenesis and treatment implications. Otolaryngol Clin N Am. 44(3):685–695CrossRefGoogle Scholar
  5. 5.
    Saleh K (2014) Evaluation on quality of life in patients with nasal polyposis managed with optimal medical therapy. Allergy Rhinol 5:e2–e8Google Scholar
  6. 6.
    Rimmer J, Fokkens W, Chong LY, Hopkins C (2014) Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps. Cochrane Database Syst Rev 2014(12):CD006991Google Scholar
  7. 7.
    Gelardi M et al (2009) Nasal-sinus polyposis: clinical-cytological grading and prognastic index of relapse. J Biol Regul Homeost Agents 23:133–140Google Scholar
  8. 8.
    Gelardi M et al (2017) Non-surgical management of chronic rhinosinusitis with nasal polyps based on clinical-cytological grading: a precision medicine-based approach. Acta Otorhinolaryngol Ital 37(1):38–45PubMedPubMedCentralGoogle Scholar
  9. 9.
    Passalacqua G, Canonica GW (2015) AIT (allergen immunotherapy): a model for the “precision medicine”. Clin Mol Allergy 8:13–24Google Scholar
  10. 10.
    Alobid I, Mullol J (2012) Role of medical therapy in the management of nasal polyps. Curr Allergy Asthma Rep 12:144–153CrossRefGoogle Scholar
  11. 11.
    Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG (2017) Prevention and management of glucocortcoid-induced side effects: a comprehensive review. A review of glucocorticoid pharmacology and bone health. J Am Acad Dermatol 76(1):1–9CrossRefGoogle Scholar
  12. 12.
    Compston J (2010) Management of glucocorticoid-induced osteoporosis. Nat Rev Rheumatol 6:82–88CrossRefGoogle Scholar
  13. 13.
    Meltzer EO, Hamilos DL, Hadley JA et al (2006) Rhinosinusitis: developing guidance for clinical trials. Rhinosinusitis Initiative. J Allergy Clin Immunol 118(5 Suppl):S17–S61CrossRefGoogle Scholar
  14. 14.
    Bousquet J, Heinzerling L, Bachert C et al (2012) Practical guide to skin prick tests in allergy to aeroallergens. Allergy 67:18–24CrossRefGoogle Scholar
  15. 15.
    Gelardi M, Iannuzzi L, Quaranta N, Landi M, Passalacqua G (2016) Nasal cytology: practical aspects and clinical relevance. Clin Exp Allergy 46(6):785–792CrossRefGoogle Scholar
  16. 16.
    Gelardi M (2012) Atlas of nasal cytology, 2nd edn. Edi Ermes, MilanGoogle Scholar
  17. 17.
    Bazzocchi A, Ponti F, Albisinni U, Battista G, Guglielmi G (2016) DXA: techinical aspects and application. Eur J Radiol 85(8):1481–1492CrossRefGoogle Scholar
  18. 18.
    Kling JM, Clarke B, Sandhu NP (2014) Osteoporosis prevention, screening, and treatment: a review. J Women’s Health 23(7):563–572CrossRefGoogle Scholar
  19. 19.
    Larsen PL, Tos M (1991) Origin of nasal polyps. Laryngoscope 101:305–312CrossRefGoogle Scholar
  20. 20.
    Akdis CA, Bachert C, Cingi C, Dykewicz MS, Hellings PW, Naclerio RM, Schleimer RP, Ledford D (2013) Endotypes and phenotypes of chronic rhinosinusitis: A PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol 131(6):1479–1490CrossRefGoogle Scholar
  21. 21.
    Gelardi M, Russo C, Fiorella ML, Fiorella R, Ciprandi G (2010) Inflammatory cell types in nasal polyps. Cytopathology 21(3):201–203CrossRefGoogle Scholar
  22. 22.
    Vaidyanathan S, Barnes M, Williamson P, Hopkinson P, Donnan PT, Lipworth B (2011) Treatment of chronic rhinosinusitis with nasal polyposis with oral steroids followed by topical steroids: a randomized trial. Ann Intern Med 154(5):293–302CrossRefGoogle Scholar
  23. 23.
    Brittany BE, Lal D (2013) Oral steroid therapy in chronic rhinosinusitis with and without nasal polyposis. Curr Allergy Asthma Rep 13(2):236–243CrossRefGoogle Scholar
  24. 24.
    Van Staa T, Hgm Leufkens, Abenhaim L, Zhang B, Cooper C (2001) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 16(3):581–588CrossRefGoogle Scholar
  25. 25.
    Etminan M, Sadatsafavi M, Ganjizadeh Zavareh S, Takkouche B, FitzGerald JM (2008) Inhaled corticosteroids and the risk of fractures in older adults: a systematic review and meta-analysis. Drug Saf 31(5):409–414CrossRefGoogle Scholar
  26. 26.
    Linee Guida per la Diagnosi, Prevenzione e Terapia dell’Osteoporosi. Società italiana dell’ Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (2015)Google Scholar
  27. 27.
    Hamada T et al (2017) Aspirin use and colorectal cancer survival according to tumor CD274 (programmed cell death 1 ligand 1) expression status. J Clin Oncol 13:JCO2O16707547Google Scholar
  28. 28.
    Drew DA et al (2017) ASPirin Intervention for the REDuction of colorectal cancer risk (ASPIRED): a study protocol for randomized controlled trial. Trials 18(1):50CrossRefGoogle Scholar
  29. 29.
    Hanson L (2013) Use of the Frax screening tool to assess fracture risk in a long term care facility. Consult Pharm 28(7):426–431CrossRefGoogle Scholar
  30. 30.
    Sozen T, Ozisik L, Basaran NC (2017) An overview and management of osteoporosis. Eur J Rheumatol 4(1):46–56CrossRefGoogle Scholar
  31. 31.
    Dalle Carbonare L et al (2001) Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis. J Bone Miner Res 16:97–103CrossRefGoogle Scholar
  32. 32.
    Gelardi M, De Candia N, Quaranta N, Russo C, Pecoraro P, Mancini M, Luperto P, Lombardo G, Macchi A, Bocciolini C, Ciofal A, De Corso E, Ciprandi G (2016) The relevance of counseling in pts with nasal polyps. Acta Otorhinolaryngol Ital 98:23–28Google Scholar
  33. 33.
    Contrera KJ, Ishii LE, Setzen G et al (2015) Accountable care organizations and otolaryngology. Otolaryngol Head Neck Surg 153:170–174CrossRefGoogle Scholar
  34. 34.
    Gandhi NA et al (2016) Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov 15(1):35–50CrossRefGoogle Scholar
  35. 35.
    Penn R, Mikula S (2007) The role of anti-IgE immunoglobulin therapy in nasal polyposis: a pilot study. Am J Rhinol 21:428–432CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory OrgansUniversity of Bari Aldo MoroBariItaly
  2. 2.Orthopaedic, Trauma and Spine Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of MedicineUniversity of Bari Aldo Moro, AOU Consorziale PoliclinicoBariItaly
  3. 3.Ospedale Policlinico San MartinoGenoaItaly

Personalised recommendations