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Effect of Inhaled Glucocorticoids and β2 Agonists on Vertebral Fracture Risk in COPD Patients: The EOLO Study

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Abstract

Although inhaled glucocorticoids (GCs) and β2 agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and β2 agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose (>1,500 μg) of inhaled GCs (OR = 1.4, CI 1.04–1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03–2.94). Inhaled β2 agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28–3.28, and OR = 1.40, CI 1.06–1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not β2 agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.

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Acknowledgements

The Evaluation of Obstructive Lung Disease and Osteoporosis (EOLO) study group includes the following (all in Italy): Angeli A, De Rose V, Orbassano (TO); Cravero M, Fantino S, Torino; Isaia G, Baldi S, Torino; Cisari C, Ronco M, Novara; Rocchetta PA, Polla B, Alessandria; Mondavio M, Ferraro G, Acqui Terme (AL); Bianchi G, Bonaria M, Arenzano (GE); Versace F, Vacca N, Savona; Calitro M, Iaffaldano A, Canosa di Puglia (BA); Muratore M, Mandurino L, S. Cesareo di Lecce (LE); Maugeri D, Distefano S, Catania; Fiore CE, Di Maria G, Catania; Frisina N, Girbino G, Messina; Rossetto S, Rossetto G, Piazza Armerina (EN); Pedrazzoni M, Cuomo A, Parma; Trotta Francesco, Potena A, Ferrara; Biondi M, Fiorentini F, Forlì; Malavolta N, Fagiani A, Bologna; Del Forno L, Colaneri A,Vasto (CH); De Felice A, De Matthaeis G, Lanciano (CH); Di Matteo L, Cortese G, Pescara; Mancini G, Tubaldi A. Macerata; Pozone M, Fiore Donati A, L’Aquila; Sfrappini M, Olori G, S. benedetto del Tronto (AP); Silveri F, Subiaco S, Jesi (AN); Latte VM, Ricciardi C, Napoli; Noverino L, Tallarico L, Napoli; Del Puente A, Zedda A, Napoli; Borg MJ, Longobardi U, Napoli; Cerqua R, Califano M, San Felice a Cancello (CE); Aversa A, Battaglia E, Milano; Santi I, Caratozzolo O, Milano; Tenca P, Davoli C, Bosio G, Cremona; Cavaiani P, Alessandrini A, Abbiategrasso (MI); Rondena M, Grechi A, Legnano; Galimberti G, Ciccarelli M, Rozzano (MI); Giustina A, Cantucci C, Brescia; Giannini S, Zuin R; Padova; Bertoldo F, Ferrari M, Verona; Adami S, Cipriani A, Valeggio (VR); Bortolotti R, Sella D, Trento; Schinella D, Mazza F, Pordenone; Di Virgilio R, Santelli G, Treviso; Tartarelli G, Vincenti R, Massa; Bertolucci D, Torrini A, Lido di Camaiore (LU); Di Munno O, Paggiaro P, Pisa; Sabadini L, Naldi M, Arezzo; Brandi ML, Pistoleri M, Firenze; Nuti R, Frediani B, Rottoli P, Siena; Cecchetti R, Faloppa C, Pontedera (PI); Bancheri C, Trequatrini T, Roma; Falaschi P, Mariotta S, Roma; Napoletano C, Dominaci M, Latina.

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Authors and Affiliations

  1. Department of Internal Medicine, Endocrine-Metabolic Science, and Biochemistry, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy

    S. Gonnelli, C. Caffarelli, S. Rossi & R. Nuti

  2. CNR Aging Branch, University of Padua, Padua, Italy

    S. Maggi, P. Siviero & G. Crepaldi

  3. Department of Radiology, Scientific Institute Hospital, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy

    G. Guglielmi

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  1. S. Gonnelli
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  2. C. Caffarelli
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  3. S. Maggi
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  4. G. Guglielmi
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  5. P. Siviero
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  6. S. Rossi
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  7. G. Crepaldi
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  8. R. Nuti
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Correspondence to S. Gonnelli.

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The authors have stated that they have no conflict of interest.

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Gonnelli, S., Caffarelli, C., Maggi, S. et al. Effect of Inhaled Glucocorticoids and β2 Agonists on Vertebral Fracture Risk in COPD Patients: The EOLO Study. Calcif Tissue Int 87, 137–143 (2010). https://doi.org/10.1007/s00223-010-9392-x

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  • DOI: https://doi.org/10.1007/s00223-010-9392-x

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