Abstract
Background: Severe asthma is associated with an increased risk of osteoporosis, largely due to chronic corticosteroid exposure and persistent systemic inflammation. Data from different international registries indicate a significant prevalence of osteoporosis among patients with severe asthma, with large variations attributed to differences in treatment strategies and optimization of care. Aims and Methods: This study aims to assess the prevalence of osteoporosis among patients with severe asthma enrolled in the Severe Asthma Network Italy (SANI) registry who are receiving treatment with monoclonal antibodies (mAbs) and/or long-acting muscarinic antagonists (LAMAs) and compare the characteristics of patients with and without osteoporosis to identify key risk factors contributing to osteoporosis. Results: A total of 1813 patients receiving Step 5 GINA (mAbs, LAMAs) treatment were included in the final analysis, of whom 282 (15.5%) had osteoporosis. Osteoporosis prevalence was significantly higher in women (20.3%) compared to men (8.0%). The prevalence also increased with age (p < 0.001) and with asthma duration (p = 0.008). Patients with osteoporosis exhibited poorer asthma control, lower lung function (FEV1 and FVC), a higher rate of exacerbations, and more frequent chronic oral corticosteroid (OCS) use compared to those without osteoporosis. Nasal polyposis was not significantly associated with osteoporosis in this cohort. Conclusions: Osteoporosis is highly prevalent in individuals with severe asthma, mainly due to chronic corticosteroid exposure and persistent inflammation, and is associated with asthma duration, sex, age, frequent exacerbations, cumulative exposure to OCS, and reduced lung function. Early recognition of osteoporosis risk is essential, and biologic therapies offer a promising strategy to reduce OCS dependence, mitigate adverse effects, and improve long-term outcomes.