Back to Browse Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 4

Long-term therapy in COPD: any evidence of adverse effect on bone?

Authors Arnulf Langhammer, Siri Forsmo, Unni Syversen

Published 30 September 2009 Volume 2009:4 Pages 365—380


Review by Single-blind

Peer reviewer comments 2

Arnulf Langhammer1, Siri Forsmo2, Unni Syversen3,4

1HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Verdal, Norway; 2Department of Public Health and General Practice, NTNU, Trondheim, Norway; 3Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway; 4Department of Endocrinology, St. Olav’s University Hospital, Trondheim, Norway

Abstract: Patients with COPD have high risk for osteoporosis and fractures. Hip and vertebral fractures might impair mobility, and vertebral fractures further reduce lung function. This review discusses the evidence of bone loss due to medical treatment opposed to disease severity and risk factors for COPD, and therapeutic options for the prevention and treatment of osteoporosis in these patients. A review of the English-language literature was conducted using the MEDLINE database until June 2009. Currently used bronchodilators probably lack adverse effect on bone. Oral corticosteroids (OCS) increase bone resorption and decrease bone formation in a dose response relationship, but the fracture risk is increased more than reflected by bone densitometry. Inhaled corticosteroids (ICS) have been associated with both increased bone loss and fracture risk. This might be a result of confounding by disease severity, but high doses of ICS have similar effects as equipotent doses of OCS. The life-style factors should be modified, use of regular OCS avoided and use of ICS restricted to those with evidenced effect and probably kept at moderate doses. The health care should actively reveal risk factors, include bone densitometry in fracture risk evaluation, and give adequate prevention and treatment for osteoporosis.

Keywords: COPD, corticosteroids, bronchodilators, bone mineral density, osteoporosis, fractures

General overview

Licence for Fig 2 is uploaded

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 


Readers of this article also read:

Inorganic nanolayers: structure, preparation, and biomedical applications

Saifullah B, Hussein MZB

International Journal of Nanomedicine 2015, 10:5609-5633

Published Date: 2 September 2015

Spinal cord stimulation for treatment of the pain associated with hereditary multiple osteochondromas

Mirpuri RG, Brammeier J, Chen H, Hsu FP, Chiu VK, Chang EY

Journal of Pain Research 2015, 8:557-560

Published Date: 18 August 2015

Nivolumab in the treatment of malignant melanoma: review of the literature

Mashima E, Inoue A, Sakuragi Y, Yamaguchi T, Sasaki N, Hara Y, Omoto D, Ohmori S, Haruyama S, Sawada Y, Yoshioka M, Nishio D, Nakamura M

OncoTargets and Therapy 2015, 8:2045-2051

Published Date: 6 August 2015

In silico ordinary differential equation/partial differential equation hemodialysis model estimates methadone removal during dialysis

Linares OA, Schiesser WE, Fudin J, Pham TC, Bettinger JJ, Mathew RO, Daly AL

Journal of Pain Research 2015, 8:417-429

Published Date: 22 July 2015

miR-32 functions as a tumor suppressor and directly targets SOX9 in human non-small cell lung cancer

Zhu D, Chen H, Yang X, Chen W, Wang L, Xu J, Yu L

OncoTargets and Therapy 2015, 8:1773-1783

Published Date: 20 July 2015

Photo activation of HPPH encapsulated in “Pocket” liposomes triggers multiple drug release and tumor cell killing in mouse breast cancer xenografts

Sine J, Urban C, Thayer D, Charron H, Valim N, Tata DB, Schiff R, Blumenthal R, Joshi A, Puri A

International Journal of Nanomedicine 2015, 10:125-145

Published Date: 19 December 2014

Electrospun fibrous scaffolds combined with nanoscale hydroxyapatite induce osteogenic differentiation of human periodontal ligament cells

Wu XN, Miao LY, Yao YF, Wu WL, Liu Y, Chen XF, Sun WB

International Journal of Nanomedicine 2014, 9:4135-4143

Published Date: 27 August 2014

Nutritional deficits in elderly smokers with respiratory symptoms that do not fulfill the criteria for COPD

Obase Y, Mouri K, Shimizu H, Ohue Y, Kobashi Y, Kawahara K, Oka M

International Journal of Chronic Obstructive Pulmonary Disease 2011, 6:679-683

Published Date: 9 December 2011

Study design considerations in a large COPD trial comparing effects of tiotropium with salmeterol on exacerbations

Kai-Michael Beeh, Bettina Hederer, Thomas Glaab, Achim Müller, Maureen Rutten-van Moelken, et al

International Journal of Chronic Obstructive Pulmonary Disease 2009, 4:119-125

Published Date: 26 February 2009