TY - JOUR
T1 - Prevalence and Progression of Osteoporosis in Patients With COPD. Results From TORCH
AU - Ferguson, Gary T
AU - Calverley, Peter M A
AU - Anderson, Julie A
AU - Jenkins, Christine R
AU - Jones, Paul W
AU - Willits, Lisa R
AU - Yates, Julie C
AU - Vestbo, Jørgen
AU - Celli, Bartolome
PY - 2009
Y1 - 2009
N2 - BACKGROUND: Osteoporosis is common in patients with COPD but its prevalence and progression are not well characterized. Concerns have been raised over the possible deleterious effect of long-term therapy with inhaled corticosteroids on bone density in this population. Here we investigated the long-term effects of fluticasone propionate (FP) alone, salmeterol (SAL) alone, and their combination (SFC) on bone mineral density (BMD) and bone fractures in moderate-severe COPD patients in the TORCH study. METHODS: A randomized, double-blind, parallel-group, placebo-controlled study conducted at 88 United States centers involving 658 patients (a sub-set of 6184 international subjects in TORCH). Placebo, SAL 50 mug, FP 500 mug or SFC 50/500 mug twice daily were given for 3 years. Baseline and yearly BMD at the hip and lumbar spine were performed. Incidence of traumatic and nontraumatic bone fractures was recorded. RESULTS: At baseline, 18% of men and 30% of women had osteoporosis and 42% of men and 41% of women had osteopenia based on BMD assessments. 43% of subjects completed all testing. Changes in BMD at the hip and lumbar spine > 3 years were small. No significant differences were observed between treatment arms (adjusted mean percent change from baseline at hip was -3.1% for placebo, -1.7% for SAL, -2.9% for FP, and -3.2% for SFC while the corresponding changes for the lumbar spine were 0, 1.5%, -0.3%, and -0.3% for placebo, SAL, FP and SFC, respectively). The incidence of fractures was low and similar for all treatments (5.1-6.3%). CONCLUSIONS: Osteoporosis is highly prevalent in patients with COPD, irrespective of gender. In the TORCH study, no significant effect on BMD was detected for inhaled corticosteroid therapy compared with placebo.
AB - BACKGROUND: Osteoporosis is common in patients with COPD but its prevalence and progression are not well characterized. Concerns have been raised over the possible deleterious effect of long-term therapy with inhaled corticosteroids on bone density in this population. Here we investigated the long-term effects of fluticasone propionate (FP) alone, salmeterol (SAL) alone, and their combination (SFC) on bone mineral density (BMD) and bone fractures in moderate-severe COPD patients in the TORCH study. METHODS: A randomized, double-blind, parallel-group, placebo-controlled study conducted at 88 United States centers involving 658 patients (a sub-set of 6184 international subjects in TORCH). Placebo, SAL 50 mug, FP 500 mug or SFC 50/500 mug twice daily were given for 3 years. Baseline and yearly BMD at the hip and lumbar spine were performed. Incidence of traumatic and nontraumatic bone fractures was recorded. RESULTS: At baseline, 18% of men and 30% of women had osteoporosis and 42% of men and 41% of women had osteopenia based on BMD assessments. 43% of subjects completed all testing. Changes in BMD at the hip and lumbar spine > 3 years were small. No significant differences were observed between treatment arms (adjusted mean percent change from baseline at hip was -3.1% for placebo, -1.7% for SAL, -2.9% for FP, and -3.2% for SFC while the corresponding changes for the lumbar spine were 0, 1.5%, -0.3%, and -0.3% for placebo, SAL, FP and SFC, respectively). The incidence of fractures was low and similar for all treatments (5.1-6.3%). CONCLUSIONS: Osteoporosis is highly prevalent in patients with COPD, irrespective of gender. In the TORCH study, no significant effect on BMD was detected for inhaled corticosteroid therapy compared with placebo.
U2 - 10.1378/chest.08-3016
DO - 10.1378/chest.08-3016
M3 - Journal article
C2 - 19581353
SN - 1931-3543
VL - 136
SP - 1456
EP - 1465
JO - Chest
JF - Chest
IS - 6
ER -