Published ahead of print on September 16, 2004, doi:10.1164/rccm.200310-1349OC
© 2004 American Thoracic Society doi: 10.1164/rccm.200310-1349OC
Loss of Bone Density with Inhaled Triamcinolone in Lung Health Study IIMayo Clinic, Rochester; University of Minnesota Coordinating Center, Minneapolis, Minnesota; Johns Hopkins University School of Medicine, Baltimore; National Heart, Lung, and Blood Institute, Bethesda, Maryland; University of California, Los Angeles, California; University of Alabama at Birmingham, Birmingham, Alabama; Oregon Health Sciences University, Portland, Oregon; Henry Ford Hospital, Detroit, Michigan; and University of Utah, Salt Lake City, Utah Correspondence and requests for reprints should be addressed to John E. Connett, Ph.D., Lung Health Study Coordinating Center, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414. E-mail: john-c{at}blueox.ccbr.umn.edu 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.
Key Words: bone density • obstructive lung diseases • osteoporosis • randomized controlled trials • triamcinolone acetonide This article has been cited by other articles:
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