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Am Fam Physician. 2002;66(6):1066

Glucocorticoids are frequently used in the treatment of chronic obstructive pulmonary disease (COPD). Patients may take inhaled corticosteroids on a regular basis. In addition, systemic glucocorticoids may be used to treat acute exacerbations. One of the serious side effects of glucocorticoid therapy is osteoporosis. The loss of bone mass and increased fracture risk are related to the cumulative amount of glucocorticoids used. Numerous studies have shown that the use of glucocorticoids in male patients increases their risk for fractures, but few studies have looked at the impact of various treatment regimens on bone mass in this group. Dubois and associates studied the impact of different glucocorticoid treatment regimens on bone density measurements in adult men with COPD.

Male patients with the diagnosis of COPD who were cared for in a pulmonary clinic over a one-year period were evaluated for the study. To be included in the study, patients had to have a diagnosis of COPD that had been established for at least five years. The patients were divided into four groups: group 1 used at least 10 mg of prednisolone daily; group 2 had intermittent treatment with prednisolone in cumulative doses of at least 1,000 mg; group 3 had intermittent doses, but the cumulative dose was less than 1,000 mg; and group 4 was not treated with prednisolone. All participants who met the inclusion criteria had their bone mineral density (BMD) measured by dual energy x-ray absorptiometry. Areas evaluated included the lumbar spine, hip, and femoral neck. In addition, pulmonary function studies were performed.

Osteoporosis (T score at least 2.5 standard deviations) was found in 31 percent of lumbar spines, 36 percent of hip regions, and 40 percent of femoral neck regions. The cumulative steroid dose was highest in group 1 (continuous therapy). However, after adjusting for body mass index and lung function, the group treated with at least 1,000 mg of cumulative glucocorticoids (group 2) had the lowest BMD measurements at all three sites.

The authors conclude that patients with COPD who take more than 1,000 mg of prednisolone on an intermittent basis for treatment of acute exacerbations have a higher risk of developing osteoporosis than those on continuous therapy. They also stated that patients with COPD receiving multiple glucocorticoid courses of therapy should have BMD measurements at an early phase of disease management.

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Copyright © 2002 by the American Academy of Family Physicians.

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