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Dual Energy X-ray Absorptiometry Outcomes in Male COPD Patients After Treatment With Different Glucocorticoid Regimens^*

^* From the Department of Pulmonary Diseases (Dr. Dubois), Reinier de Graaf Groep Delft and Voorburg; the Department of Clinical Pharmacology (Dr. Röder), Academical Medical Center, University of Amsterdam; the Department of Pulmonary Diseases (Dr. Dekhuijzen), University Medical Center Nijmegen; Department of Clinical Epidemiology and Biostatistics (Dr. Zwinderman), Academic Medical Center, Amsterdam; and the Department of Internal Medicine and Endocrinology (Dr. Schweitzer), Reinier de Graaf Groep Delft and Voorburg, the Netherlands.

Correspondence to: Emile F. Dubois, MD, FCCP, Department of Pulmonary Diseases, Reinier de Graaf Groep Delft and Voorburg, Fonteynenburglaan 5, PBX 998, 2270 AZ Voorburg, the Netherlands; e-mail: dubois{at}rdgg.nl

Study objectives: To compare bone mineral density (BMD) outcomes of patients who received continuous oral systemic glucocorticoids (GCs) with BMD outcomes of patients who received multiple GC courses, oral or IV.

Design: Cross-sectional study.

Participants: Eighty-six white men with COPD selected from the outpatient clinic for pulmonary diseases.

Intervention: Data analysis from medical records, bone densitometry, and pulmonary function tests of consecutive selected patients. Inclusion period into the study was exactly 1 year.

Measurements and results: Ten patients received oral prednisolone daily (group 1). Eleven patients were treated for several exacerbations with multiple systemic prednisolone courses, up to a period of 2 weeks per course, with a cumulative dose of 1,000 mg (group 2). Likewise, 28 patients were treated with multiple systemic prednisolone courses, but with a cumulative dose < 1,000 mg (group 3). Thirty-seven patients were never treated with systemic prednisolone, and partly with inhaled corticosteroids (ICS) [group 4]. All groups were balanced for age and pack-years of smoking. In group 2, body mass index (BMI) and FEV₁ were lowest and hyperinflation was highest. The cumulative systemic prednisolone dose was highest in group 1, irrespective of the additional ICS treatments. Dual energy x-ray absorptiometry scanning of the lumbar spine, total hip, and femoral neck regions revealed a T score 2.5 SD in 27 patients (31%), 31 patients (36%), and 34 patients (40%), respectively. BMD outcomes at any site were lower in patients receiving multiple systemic prednisolone courses > 1,000 mg, cumulatively (group 2), compared to the other groups, and these values were (mean ± 1 SD) 0.759 ± 0.238 g/cm², 0.683 ± 0.115 g/cm², and 0.686 ± 0.125 g/cm², respectively (p < 0.0001). Multivariate regression analysis revealed a correlation between the cumulative dose of prednisolone in group 2 and BMD of the lumbar spine (adjusted r = 0.48; p < 0.01). At the total hip and femoral neck regions, only a correlation between BMI and BMD was observed (adjusted r = 0.65 and 0.58, respectively; p < 0.0001 for both sites).

Conclusions: Despite a far lower cumulative GC dose in comparison with patients treated with systemic corticosteroids continuously, after adjusting for BMI and lung function, osteoporosis of the lumbar spine was most frequent in patients receiving > 1,000 mg of prednisolone cumulatively, administered in multiple courses for the treatment of exacerbations of COPD.

Key Words: body mass index • bone mineral density • COPD • glucocorticoid courses

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