Bone mineral density changes in male patients with chronic obstructive pulmonary disease: clinical and biochemical variables in correlation with glucocorticoids use

ABSTRACT

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 in correlation between bone mass density [BMD] and men with COPD. 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? The study included 56 male patients with documented COPD for at least two years, their age ranged 24-66 years. Subjects were divided into 3 groups group 1. Consisted of 18 patients, who were oral GCs users, group 2. consisted of 18 patients who were inhaled GCs users and group 3 consisted of 20 patients, never GCs users [this 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 Pulm. Function tests GCs use biochemical markers and clinical variables were analyzed. Of all 56 patients with COPD, 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 2 patients had over all bone mass loss, that was indistinguishable from those who were receiving oral GCs. Group 3 patients had less bone mass reduction than the other two groups. Of the clinical and biochemical markers measured N-telopeptide was 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 1 patients. BMI [Body Mass Index] was weakly correlated with bone mass in the 3 studied groups. Bone mass loss is a common problem in male patients with COPD, while the use of oral GCs increases the frequency of osteoporosis, inhaled GCs therapy offered to protection from bone loss. COPD patients who had never treated with GCs had also a substantial risk for osteoporosis. We advocate early screening and preventive intervention