Chest
Volume 121, Issue 5, May 2002, Pages 1456-1463
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Clinical Investigations
Copd
Dual Energy X-ray Absorptiometry Outcomes in Male COPD Patients After Treatment With Different Glucocorticoid Regimens

https://doi.org/10.1378/chest.121.5.1456Get rights and content

Study objectives

To compare bone mineral density (BMD) outcomes of patients who received continuous oral systemic glucocorticoids (GCs) with BMD outcomes of patients who received multiple GC courses, oral or IV.

Design

Cross-sectional study.

Participants

Eighty-six white men with COPD selected from the outpatient clinic for pulmonary diseases.

Intervention

Data analysis from medical records, bone densitometry, and pulmonary function tests of consecutive selected patients. Inclusion period into the study was exactly 1 year.

Measurements and results

Ten patients received oral prednisolone daily (group 1). Eleven patients were treated for several exacerbations with multiple systemic prednisolone courses, up to a period of 2 weeks per course, with a cumulative dose of ≥ 1,000 mg (group 2). Likewise, 28 patients were treated with multiple systemic prednisolone courses, but with a cumulative dose < 1,000 mg (group 3). Thirty-seven patients were never treated with systemic prednisolone, and partly with inhaled corticosteroids (ICS) [group 4]. All groups were balanced for age and pack-years of smoking. In group 2, body mass index (BMI) and FEV1 were lowest and hyperinflation was highest. The cumulative systemic prednisolone dose was highest in group 1, irrespective of the additional ICS treatments. Dual energy x-ray absorptiometry scanning of the lumbar spine, total hip, and femoral neck regions revealed a T score ≤ 2.5 SD in 27 patients (31%), 31 patients (36%), and 34 patients (40%), respectively. BMD outcomes at any site were lower in patients receiving multiple systemic prednisolone courses > 1,000 mg, cumulatively (group 2), compared to the other groups, and these values were (mean ± 1 SD) 0.759 ± 0.238 g/cm2, 0.683 ± 0.115 g/cm2, and 0.686 ± 0.125 g/cm2, respectively (p < 0.0001). Multivariate regression analysis revealed a correlation between the cumulative dose of prednisolone in group 2 and BMD of the lumbar spine (adjusted r = 0.48; p < 0.01). At the total hip and femoral neck regions, only a correlation between BMI and BMD was observed (adjusted r = 0.65 and 0.58, respectively; p < 0.0001 for both sites).

Conclusions

Despite a far lower cumulative GC dose in comparison with patients treated with systemic corticosteroids continuously, after adjusting for BMI and lung function, osteoporosis of the lumbar spine was most frequent in patients receiving > 1,000 mg of prednisolone cumulatively, administered in multiple courses for the treatment of exacerbations of COPD.

Section snippets

Study Design

Previous uses of systemic GCs and ICS in a cohort of white male patients with COPD were carefully assessed from hospital patient records obtained at the pulmonary diseases outpatient clinic of the Reinier de Graaf Groep, in Delft and Voorburg, the Netherlands. Patients included in the study consulted one lung physician consecutively. Every new patient with COPD and all those with a previous diagnosis of COPD were invited to participate in the study. Informed consent was obtained from each

Patient Characteristics

As demonstrated in Table 1, the mean ages of patients in the four groups were similar, but body mass index (BMI) was lower in group 2. Group 4 consisted of 22 non-ICS and 15 ICS users (60 ± 14 years of age vs 69 ± 11 years of age; p < 0.05). In these two subgroups, spinal BMD outcomes were similar (1.17 ± 0.17 g/cm2 vs 1.12 ± 0.22 g/cm2; p < 0.44), but total hip and femoral neck BMD values were lower in the ICS users (0.98 ± 0.12 g/cm2 vs 0.88 ± 0.16 g/cm2, and 0.92 ± 0.12 g/cm2 vs 0.82 ±

Discussion

In this cross-sectional study, we tested the hypothesis that administration of multiple courses of GCs would elicit more harmful effects to bone than continuous GC treatment regimens. In the analysis, we calculated cumulative GCs usage throughout lifetime, and it was found that when adjusted for BMI and PFT, lowest spinal BMD was observed in patients receiving GC in multiple courses, lasting up to 2 weeks per course, > 1,000 mg of prednisolone cumulatively. Osteoporosis of the lumbar spine was

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