Loss of bone density with inhaled triamcinolone in Lung Health Study II.
Inhaled glucocorticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease. No adverse effect on bone mineral density (BMD) has been proven. In a randomized double-blind, placebo-controlled trial at seven centers in North America, we recruited 412 current smokers or recent quitters with mild to moderate chronic obstructive pulmonary disease. They used inhaled triamcinolone acetonide, 600 mcg, or placebo, twice daily. We measured femoral neck and lumbar spine BMD at baseline and after 1 and 3 years, and serum osteocalcin at baseline, 3 months, 1 year, and 3 years. After 3 years, BMD at the femoral neck decreased 1.78% more with ICS than with placebo (p < 0.001). More participants in the ICS group experienced 6% or more loss of femoral neck BMD (p = 0.002). Lumbar spine BMD increased in the placebo group by 0.98% but decreased by 0.35% in the ICS group (a difference of 1.33%, p = 0.007). Changes in osteocalcin did not correlate with changes in BMD. Fractures, lost height, or osteoporosis diagnoses were not increased among ICS users compared with placebo users. In summary, the use of inhaled triamcinolone acetonide was associated with loss of BMD at the femoral neck and lumbar spine after 3 years of treatment.
Scanlon
Paul D
PD
Mayo Clinic, Rochester, MN, USA
Connett
John E
JE
Wise
Robert A
RA
Tashkin
Donald P
DP
Madhok
Thelma
T
Skeans
Melissa
M
Carpenter
Paul C
PC
Bailey
William C
WC
Buist
A Sonia
AS
Eichenhorn
Michael
M
Kanner
Richard E
RE
Weinmann
Gail
G
D000280:Administration, Inhalation; D015519:Bone Density / Q000187:drug effects*; D001862:Bone Resorption / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000378:metabolism*; D013997:Time Factors; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects*
D005938:Glucocorticoids; D014221:Triamcinolone