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