This study was performed to determine the effects of high doses of two inhaled corticosteroids, beclomethasone dipropionate and budesonide, on biochemical indices of bone turnover (urinary hydroxyproline:creatinine and calcium: creatinine ratios, plasma alkaline phosphatase, and parathyroid hormone). Twelve healthy male doctors, aged [25][26][27][28][29][30][31][32][33][34][35][36]

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Background Although osteoporosis is a well known side effect of long term prednisolone, the effects of a short course are less clear. Biochemical markers of bone turnover were therefore studied in 10 men with chronic obstructive airways disease who required assessment of "steroid reversibility" (mean age 65 years, mean FEV, Although increases in 24 hour urinary calcium excretion have been reported during the first four weeks of corticosteroid treatment,'0 1' changes in urinary hydroxyproline excretion, an indicator of increased bone resorption, are less well established."The aim of this study was therefore to investigate bone turnover after two and four weeks of prednisolone in patients with chronic obstructive airways disease who required a "steroid trial" as part of their routine clinical assessment. Bone resorption was assessed biochemically and non-invasively, as in our previous study, by measurement of the fasting urinary hydroxyproline:creatinine ratio and the urinary calcium:creatinine ratio.'213 Bone formation was assessed by measurement of serum alkaline phosphatase"3 and serum osteocalcin.'4'5 Methods PATIENTS Ten men (mean age 65, range 56-75 years) were recruited from the outpatient chest clinic. Each had chronic obstructive airways disease, with abnormal values in tests of expiratory flow, which had not changed substantially over several months and which were not related to specific causes ofairflow obstruction, as defined by the American Thoracic Society.'6 All but one were previous or current smokers. The mean forced expiratory volume in one second (FEVy) was 12 (range 0 6-2 0)1 and in all patients was less than 65% of the predicted value. The mean forced vital capacity (FVC) was 2-2 (range 14-3-2)1 and the FEV,/FVC ratio was below 70% in all subjects. All patients were clinically stable.Patients were excluded if there was any evidence of active bone disease, such as osteoporosis, osteomalacia, Paget's disease, or recent fracture; if they had received oral steroid treatment in the past two months; or if they had any other important medical problems or were taking medication known to alter bone metabolism, such as thiazides or calcitonin.' STUDY DESIGN This was a single blind, placebo controlled study lasting eight weeks. Placebo was given for two weeks during an initial run in period. Baseline measurements were made at the beginning and end of this period and then all patients were given four weeks ofprednisolone, 20 mg daily, during which two further sets of measurements were made after two and four weeks of active treatment. Patients then took 418 on 11 May 2018 by guest. Protected by copyright.

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