title: Effect of inhaled glucocorticoids and beta(2) agonists on vertebral fracture risk in COPD patients: the EOLO study.
abstract: Although inhaled glucocorticoids (GCs) and beta(2) agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and beta(2) agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose (>1,500 microg) of inhaled GCs (OR = 1.4, CI 1.04-1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03-2.94). Inhaled beta(2) agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28-3.28, and OR = 1.40, CI 1.06-1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not beta(2) agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.
authors.affiliation: Department of Internal Medicine, Endocrine-Metabolic Science, and Biochemistry, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100 Siena, Italy. gonnelli@unisi.it
authors.forename: S
authors.initials: S
authors.lastname: Gonnelli
authors.forename: C
authors.initials: C
authors.lastname: Caffarelli
authors.forename: S
authors.initials: S
authors.lastname: Maggi
authors.forename: G
authors.initials: G
authors.lastname: Guglielmi
authors.forename: P
authors.initials: P
authors.lastname: Siviero
authors.forename: S
authors.initials: S
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Crepaldi
authors.forename: R
authors.initials: R
authors.lastname: Nuti
mesh_terms: D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D001842:Bone and Bones / Q000187:drug effects; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016021:Epidemiologic Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy*; D012306:Risk; D016103:Spinal Fractures / Q000139:chemically induced* / Q000150:complications
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D005938:Glucocorticoids