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08-12-2009 | Respiratory | Article

ICS treatment ‘does not reduce bone density in COPD patients’


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MedWire News: Inhaled corticosteriod (ICS) treatment has no significant effect on bone mineral density (BMD) in patients with chronic obstructive pulmonary disease (COPD), report researchers.

“Evidence suggests that the prevalence of osteoporosis in patients with COPD is high and potentially important,” explain Gary Ferguson (Pulmonary Research Institute of Southeast Michigan, Livonia, USA) and team.

But they add: “It is unknown whether osteoporosis in COPD patients is due to its systemic nature, to physical limitations imposed by the disease, or to the COPD therapies received. In particular, the association between oral corticosteroid usage and osteoporosis has raised concerns over the potential risk for osteoporosis in patients with COPD who use ICSs regularly.”

To investigate, the researchers studied data on 658 US patients with moderate-to-severe COPD who participated in the TORCH (TOwards a Revolution in COPD Health) study.

The participants were randomly assigned to take placebo (n=164), salmeterol (SAL) 50 µg alone (n=166), fluticasone propionate (FP) 500 µg alone (n=163), or a combination of SAL 50 µg/FP 500 µg (SFC; n=165) twice daily for 3 years. BMD measurements at the hip and lumbar spine were taken at baseline and then yearly during the treatment period.

At baseline, 18% of men and 30% of women had osteoporosis, and 42% and 41%, respectively, had osteopenia.

The researchers found that changes in BMD at both sites were small over the study period, with no significant differences between patients on active treatment and those taking placebo.

Specifically, patients in the placebo, SAL, FP, and SFC groups had mean hip BMD changes of -3.1%, -1.7%, -2.9%, and -3.2%, respectively, and mean lumbar spine BMD changes of 0.0%, 1.5%, -0.3%, and -0.3%, respectively.

The researchers also found that the incidence of bone fractures was low and similar in all treatment arms, ranging from 5.1% to 6.3%.

“We observed a high prevalence of osteopenia and osteoporosis in men and women with COPD [and] it is important to remain aware of these potentially treatable conditions,” the researchers comment in the journal Chest.

Nevertheless, they conclude: “The results of the TORCH study are reassuring as we did not detect that either SFC or its individual components had a significant effect on BMD compared with placebo over 3 years.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Mark Cowen

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