Bone mass loss in chronic obstructive pulmonary disease in males : clinical and biochemical variables in correlation with the use of glucocorticoids

الملخص EN

Recent studies have shown that osteoporosis and vertebral fractures are quite common in postmenopausal women with chronic obstructive pulmonary disease (COPD).

Few data are available on the same ailment in men.

Objective : this study was designed to investigate the prevalence of osteoporosis in men with COPD, with special regards to the role of glucocorticoids (GCs) use in these patients.

We aimed to determine factors that influence bone metabolism and the clinical variables of this group of patients.

We also tried to answer the arising question : should COPD patients be routinely evaluated for BMD.

Methodology : the study included 56 male COPD patients documented for at least two years.

Their age ranged from 24 to 66 years.

Subjects were divided into 3 groups : Group I, consisted of 18 patients, who were oral GCs users, group II, consisted of 18 patients who were inhaled GCs users and group III, consisted of 20 patients who never used GCs.

The latter group was considered as the control group.

All subjects underwent measurement of BMD; pulmonary function tests (PFTs) and a number of biochemical markers of bone metabolism.

The associations between BMD, PFTs, GCs use, biochemical markers and clinical variables were analyzed.

Results : the prevalence of osteopenia and osteoporosis, as defined by WHO criteria was 26.8 % and 21.4 % at the lumber spine, 30.4 % and 23.2 % at total hip, 35.7 % and 28.5 % at femoral neck and 32.1 % and 28.8 % for total body respectively.

Patients included group 1 had the lowest BMD at any site (p < 0.0001), group II patients had over all bone mass loss, that was indistinguishable from those who were received oral GCs and group III patients had less bone mass reduction that the other two groups.

Of the clinical and biochemical markers measured, N-telopeptide significantly correlated with bone mass (p < 0.01), but there was no correlation with other markers.

The lowest mean of FEVI (Forced Expiratory Volume in one second) was observed in group I patients.

BMI (Body Mass Index) was weakly correlated with bone mass in the 3 studied groups.

Conclusion : bone mass loss is a-common problem in male COPD patients, while the use of oral GCs increases the frequency of osteoporosis.

Inhaled GCs therapy offered no protection from bone loss.

COPD patients who were never treated with GCs had also a substantial risk for osteoporosis.

We advocate early screening and preventive intervention.