TY - JOUR
T1 - Effect of inhaled glucocorticoids and β2 agonists on vertebral fracture risk in COPD patients
T2 - The EOLO study
AU - Gonnelli, S.
AU - Caffarelli, C.
AU - Maggi, S.
AU - Guglielmi, G.
AU - Siviero, P.
AU - Rossi, S.
AU - Crepaldi, G.
AU - Nuti, R.
PY - 2010
Y1 - 2010
N2 - Although inhaled glucocorticoids (GCs) and β2 agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and β2 agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose ([1,500 lg) of inhaled GCs (OR = 1.4, CI 1.04-1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03-2.94). Inhaled β2 agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28-3.28, and OR = 1.40, CI 1.06-1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not β2 agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.
AB - Although inhaled glucocorticoids (GCs) and β2 agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and β2 agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose ([1,500 lg) of inhaled GCs (OR = 1.4, CI 1.04-1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03-2.94). Inhaled β2 agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28-3.28, and OR = 1.40, CI 1.06-1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not β2 agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.
KW - COPD
KW - Inhaled glucocorticoid
KW - QUS
KW - Vertebral fracture
KW - β2 agonist
UR - http://www.scopus.com/inward/record.url?scp=79952111554&partnerID=8YFLogxK
U2 - 10.1007/s00223-010-9392-x
DO - 10.1007/s00223-010-9392-x
M3 - Article
SN - 0171-967X
VL - 87
SP - 137
EP - 143
JO - Calcified Tissue International
JF - Calcified Tissue International
IS - 2
ER -