Serum osteocalcin and procollagen as markers for the risk of osteoporotic fracture in corticosteroid-treated asthmatic adults.

BACKGROUND: Dual energy x-ray absorptiometry provides the definitive measure of osteoporotic fracture risk. OBJECTIVE: We sought to determine whether metabolic measures of bone formation and/or common features of clinical hypercortisonism provide a useful guide in selecting corticosteroid-treated asthmatic patients for referral for bone densitometry. METHODS: We measured bone density and 8 AM serum osteocalcin, procollagen, and cortisol levels in 52 asthmatic adults aged 60.7 +/- 12.6 years (mean +/- SD). Years of steroid exposure for these patients was 11.8 +/- 10.7 (prednisone) and 11.78 +/- 4.98 (inhaled steroid). Using stepwise logistic regression, we assessed the capacity of the osteocalcin and procollagen levels, with or without the cortisol level, age, clinical features of hypercortisonism, and different lifetime exposures to inhaled and oral steroids for distinguishing between patients with greater or lesser risk of fracture. RESULTS: Osteoporosis, defined as a bone density T score below -2.5, affected 26% of the group at the spine and 63% at the hip. At the spine, greater risk was associated only with lower cortisol levels (P =.003). Diagnostic accuracy was 71%, the false-positive rate was 26%, and the false-negative rate was 31%. At the hip, greater risk was associated with lower cortisol levels (P =.002), longer prednisone exposure, (P =.003), lower current doses of prednisone (P =.01) and inhaled steroid (P =.02), and older age (P =.01). Diagnostic accuracy was 83%, the false-positive rate was 13%, and the false-negative rate was 21%. CONCLUSIONS: Neither osteocalcin nor procollagen nor any of the clinical criteria analyzed proved sufficiently accurate to be reliable as indicators of the risk of fracture in these elderly, corticosteroid-treated asthmatic adults. They are therefore not useful for selecting such patients for diagnostic densitometry.

[A comparative study of the action of different doses of prednisone and budesonide on the biochemical indices of bone metabolism in healthy volunteers]. / Sravnitel'noe issledovanie vozdeistviia razlichnykh doz prednizona i budezonida na biokhimicheskie pokazateli kostnogo metabolizma zdorovykh dobrovol'tsev.

Our objective in this study was to determine effects, if any, of different doses of of prednisone and the inhalant steroid budesonide on the indices for bone formation (osteocalcin, PICP levels) and bone resorption (piridinoline, deoxypiridinoline, and hydroxyproline) in healthy volunteers (n = 78). In the two-week study, budesonide administered in daily doses of 0.8 and 1.2 mg failed to significantly decrease serum osteocalcin; even in excessively high doses of 2.4 and 3.2 mg/a day it was found out to be associated with but insignificant decrease of PICP level. Prednisone in both a 10 mg/a day and 40 mg/a day dose appeared to significantly decrease the above measures. We take it that budesonide has a lesser effect on collagen formation than it has on bone mineralization.

[The long-term use of corticosteroid inhalations in bronchial asthma patients]. / Dlitel'noe primenenie ingaliatsii kortikosteroidov u bol'nykh bronkhial'noi astmoi.

Our objective in this study was to observe how prolonged exposure to high doses of inhalation and peroral corticosteroids impacted on the risk of development of posterior subcapsular cataract (PSC). Of the 48 examinees, 27 percent revealed PSC. The presence of PSC correlated with diurnal dose of prednisone as well as with duration of its administration but no correlation was found between PSC and inhalation corticosteroids. The data obtained suggest to us that inhalation corticosteroids in hormone-dependent patients with bronchial asthma reduce the risk of PSC development.

Bone mineral density and the risk of fracture in patients receiving long-term inhaled steroid therapy for asthma.

To determine whether high-dose or prolonged inhaled steroid therapy for asthma increases a patient's risk of osteoporosis and fracture, we measured bone density in 26 men and 43 women (41 postmenopausal, all of whom had received supplemental estrogen therapy) after treatment with an inhaled steroid for 10.1 +/- 5.5 years and oral prednisone for 10.7 +/- 9.7 years (mean +/- SD). Most had stopped receiving prednisone since commencing the inhaled steroid therapy. We found that bone densities (adjusted for age and sex to yield a z score) were lower in association with higher daily doses of inhaled steroid (p = 0.013 ANCOVA) and with the duration of past prednisone therapy (p = 0.032). Larger cumulative inhaled steroid doses were associated with higher bone densities (p = 0.002) and a reduction in the numbers of patients at risk of fracture. Bone density also increased with the amount of supplemental estrogen therapy (p = 0.058) and, at equivalent levels of inhaled and oral steroid use, women showed higher bone density z scores than did men. Women with a lifetime dose of inhaled steroid greater than 3 gm had normal bone density regardless of the amount of past or current prednisone use or the current dose of inhaled steroid. These data indicate that the daily dose, but not the duration, of inhaled steroid therapy may adversely affect bone density, and that estrogen therapy may offset this bone-depleting effect in postmenopausal women.

Association of ocular cataracts with inhaled and oral steroid therapy during long-term treatment of asthma.

BACKGROUND: Posterior subcapsular cataracts (PSCs) have been reported to occur in some asthmatic patients treated with inhaled steroids. METHODS: We studied the associations between the occurrence of PSCs and inhaled and oral steroid therapy in 48 adults in a cross-sectional survey by slit lamp. Accurate records of the patients' long-term usage of these drugs were available: 9.2 +/- 5.2 years for inhaled steroid and 9.1 +/- 9.3 years for prednisone (mean +/- SD). Their current inhaled steroid dosage averaged 1.46 +/- 0.85 mg/day (range, 0 to 3.2 mg/day). RESULTS: Twenty-seven percent of the group had PSCs. The occurrence of PSCs correlated with the current daily dose and duration of prednisone use (p = 0.002 and p = 0.01, respectively), but not with the dose or duration of inhaled steroid treatment. As judged by multiple logistic regression analysis, neither the particular inhaled steroid drug used, nor its daily dose or cumulative dose, nor the additional nonsteroidal risk factors for PSCs also present in some of these patients contributed significantly to their risk of developing PSCs. CONCLUSIONS: The findings do not exclude the possibility that inhaled steroid therapy might lead to PSCs if a person has an exceptionally high inherent susceptibility. However, in the asthmatic population at large, the risk appears negligible, even if high doses of inhaled steroid are administered.

[The clinico-immunological and allergological characteristics of aspirin-induced asthma]. / Kliniko-immunologicheskie i allergologicheskie osobennosti aspirinovoi astmy.

A study is presented of 66 patients with aspirin bronchial asthma (BA) and the clinical, pathogenetical, immunological and allergological state of these patients is described. For the treatment of patients with aspirin asthma the authors recommend to use zaditen, intal, thymic preparations (thymalin, T-activin), quercetin. In mild forms of bronchial asthma aspirin desensitization is possible.

[The effect of vilozen on the immune status of bronchial asthma patients]. / Vliianie vilozena na immunnyi status bol'nykh bronkhial'noi astmoi.

An immunological study of 163 patients with different forms of bronchial asthma revealed a distinct disturbance of the cellular link of immunity in these patients. Vilosen (a native non-protein immunomodulator extracted from the thymus of animals) possessing a prevailing action on T-cells was used for correction of the immune disorders. It was found that vilosen proved effective in the complex treatment of patients with atopic associated forms of bronchial asthma.

[Effectiveness of administration of thymalin in the complex treatment of pulmonary tuberculosis]. / Effektivnost' primeneniia timalina v kompleksnom lecvhenii bol'nykh tuberkulezom legkikh.

The criteria of differential administration of thymalin in the combined management of patients with destructive pulmonary tuberculosis were defined on the basis of immunologic studies. A ++clinico-roentgenologic and immunologic evaluation of in-patient treatment of 60 cases demonstrated that a differential administration of thymalin in combination with chemotherapeutic drugs greatly shortened the stay at a hospital and increased the efficacy of treatment. Besides, more evident normalizing influence of the proposed option of therapy on the recovery of the immune system links is noted.