The influence of glucocorticoids on the bone tissue in patients with chronic obstructive pulmonary disease

Abstract

Background. According to the GOLD guidelines, glucocorticoids (GCs) are recommended for exacerbations of chronic obstructive pulmonary disease (COPD). Bone mineral density (BMD) can be reduced in case of the use of therapeutic doses of GCs. The aim of the study was to determine the influence of GCs on BMD and the frequency of osteoporosis in patients with COPD depending on the prescribed therapy. Materials and methods. We examined 202 patients with COPD (group E) in the acute phase. Group I consisted of 129 patients taking basic dual treatment, group II — 73 patients taking triple therapy with inhaled GCs. During exacerbations, systemic GCs were prescribed at the cumulative dose of 352.94 ± 30.51 mg/year. The bone state was examined using an ultrasound densitometer SONOST-2000. A Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA), Stiffness index (SI), and T- and Z-scores were determined. Results. Decreases in SI, BUA, T- and Z- scores were established in 43.51 % of the patients from the I group and 83.56 % from the II group (p < 0.05). In the II group, SI was lower by 9.54 %, BUA — by 14.35 %, SOS — by 14.57 %, T- score — by 6.9 %, Z- score — by 25.86 %; in subjects with GOLD 3: BUA — by 40.27 %, SI — by 3.25 %, T- score — by 17.9 %; in patients with GOLD 4: SI — by 19.9 %, BUA — by 77.8 %, T- score — by 5.6 % compared to the I group. Conclusions. Glucocorticoid-induced osteoporosis was diagnosed in 10.71 % of patients from the I group and 20.55 % of the II group. Its frequency depended on the stage of COPD: GOLD 3 — in 22.22 % of patients, GOLD 4 — in 50.0 % of the subjects.