Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients: Aggravating or beneficial?
Article first published online: 26 DEC 2012
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 1, pages 147–153, January 2013
How to Cite
MATHIOUDAKIS, A. G., AMANETOPOULOU, S. G., GIALMANIDIS, I. P., CHATZIMAVRIDOU-GRIGORIADOU, V., SIASOS, G., EVANGELOPOULOU, E. and MATHIOUDAKIS, G. A. (2013), Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients: Aggravating or beneficial?. Respirology, 18: 147–153. doi: 10.1111/j.1440-1843.2012.02265.x
- Issue published online: 26 DEC 2012
- Article first published online: 26 DEC 2012
- Accepted manuscript online: 18 SEP 2012 03:52AM EST
- Received 3 April 2012; invited to revise 3 May 2012; revised 28 May 2012; accepted 20 June 2012 (Associate Editor: David Hui).
- bone mineral density;
- chronic obstructive pulmonary disease;
- inhaled corticosteroids;
Background and objective: Chronic obstructive pulmonary disease (COPD) is characterized by a low-level systemic chronic inflammatory activity that is responsible for many of the disease's extra-pulmonary manifestations, including osteoporosis and fragility fractures. These manifestations are also well-documented side-effects of oral corticosteroids. It was hypothesized that low levels of inhaled corticosteroids, due to their anti-inflammatory properties and their low circulating levels, might preserve the bone mineral density (BMD) of COPD patients.
Methods: Two hundred and fifty-one male ex-smokers with COPD patients grouped on the basis of their diffusion capacity value as predominantly bronchitic or predominantly emphysematic and 313 male controls with similar age and smoking history were enrolled in the study. Each of the patient's categories was randomized into two separate subgroups. Patients enrolled in subgroups Bneg(n = 91, 36%) and Eneg(n = 37, 14.7%) were treated with long-acting β2-agonists and anticholinergics, while subgroups BICS(n = 87, 35%) and EICS(n = 38, 15.1%) were additionally receiving low-dose inhaled corticosteroids. Patients and controls were evaluated by clinical examination, lung function testing and BMD measurement every 6 months for 4 years.
Results: According to the findings, emphysematic patients demonstrated an increased rate of BMD loss compared with bronchitic patients (P = 0.01). Furthermore, a reduction of the annual BMD loss in bronchitic patients on inhaled corticosteroids (P = 0.02) was measured, without a corresponding benefit for the emphysematics (P = not significant).
Conclusions: Long-term administration of low-dose inhaled corticosteroids decelerates the annual BMD loss in bronchitic patients, possibly by reducing both pulmonary and systemic chronic inflammation caused by COPD.