Published ahead of print on September 16, 2004, doi:10.1164/rccm.200310-1349OC Am. J. Respir. Crit. Care Med., Volume 170, Number 12, December 2004, 1302-1309 A more recent version of this article appeared on December 15, 2004
Submitted on October 2, 2003 Loss of Bone Density with Inhaled Triamcinolone in Lung Health Study IIPaul D Scanlon1,1 Department of Medicine, Mayo Clinic, Rochester, MN, USA, 2 Department of Biostatistics, University of Minnesota Coordinating Center, Minneapolis, MN, USA, 3 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA, 4 Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA, 5 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, 6 Department of Medicine, Oregon Health Sciences University, Portland, OR, USA, 7 Department of Medicine, Henry Ford Hospital, Detroit, MI, USA, 8 Department of Medicine, University of Utah, Salt Lake City, UT, USA, 9 Lung Division, National Heart, Lung, and Blood Institute, Bethesda, MD, USA * To whom correspondence should be addressed. E-mail: john-c{at}blueox.ccbr.umn.edu.
Inhaled glucocorticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD). No adverse effect on bone mineral density (BMD) has been proven. In a randomized double-blind, placebo-controlled trial at 7 centers in North America, we recruited 412 current smokers or recent quitters with mild-to-moderate COPD. 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, one year, and 3 years. After three 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 Key words: bone density, clinical trials, double-blind method, forced expiratory volume, obstructive lung diseases
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6% 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, use of inhaled triamcinolone acetonide was associated with loss of BMD at the femoral neck and lumbar spine after 3 years of treatment.
