@article{3155177,
    title = "Impact of long-term treatment with low-dose inhaled corticosteroids on
the bone mineral density of chronic obstructive pulmonary disease
patients: Aggravating or beneficial?",
    author = "Mathioudakis, Alexandros G. and Amanetopoulou, Stavroula G. and and Gialmanidis, Ioannis P. and Chatzimavridou-Grigoriadou, Victoria and and Siasos, Gerasimos and Evangelopoulou, Efstathia and Mathioudakis, and Georgios A.",
    journal = "Respirology",
    year = "2013",
    volume = "18",
    number = "1",
    pages = "147-153",
    publisher = "Wiley",
    issn = "1323-7799, 1440-1843",
    doi = "10.1111/j.1440-1843.2012.02265.x",
    keywords = "bone mineral density; chronic obstructive pulmonary disease; emphysema;
inhaled corticosteroids; osteoporosis",
    abstract = "Background and objective: Chronic obstructive pulmonary disease (COPD)
is characterized by a low-level systemic chronic inflammatory activity
that is responsible for many of the disease’s extra-pulmonary
manifestations, including osteoporosis and fragility fractures. These
manifestations are also well-documented side-effects of oral
corticosteroids. It was hypothesized that low levels of inhaled
corticosteroids, due to their anti-inflammatory properties and their low
circulating levels, might preserve the bone mineral density (BMD) of
COPD patients.
Methods: Two hundred and fifty-one male ex-smokers with COPD patients
grouped on the basis of their diffusion capacity value as predominantly
bronchitic or predominantly emphysematic and 313 male controls with
similar age and smoking history were enrolled in the study. Each of the
patient’s categories was randomized into two separate subgroups.
Patients enrolled in subgroups B-neg(n = 91,36%) and E-neg(n = 37,
14.7%) were treated with long-acting beta 2-agonists and
anticholinergics, while subgroupsB(ICS)(n = 87,35%) and E-ICS(n =
38,15.1%) were additionally receiving low-dose inhaled corticosteroids.
Patients and controls were evaluated by clinical examination, lung
function testing and BMD measurement every 6 months for 4 years.
Results: According to the findings, emphysematic patients demonstrated
an increased rate of BMD loss compared with bronchitic patients (P =
0.01). Furthermore, a reduction of the annual BMD loss in bronchitic
patients on inhaled corticosteroids (P = 0.02) was measured, without a
corresponding benefit for the emphysematics (P = not significant).
Conclusions: Long-term administration of low-dose inhaled
corticosteroids decelerates the annual BMD loss in bronchitic patients,
possibly by reducing both pulmonary and systemic chronic inflammation
caused by COPD."
}