Background: Men with chronic lung disease (CLD) are at
risk for osteoporosis, but the relative contributions of their chronic
pulmonary disease, glucocorticoid therapy, and other factors toward
loss of bone has not been established. Understanding the relative
importance of these factors would assist in selecting patients for bone
densitometry screening and in policy decisions regarding Medicare
Objective: To identify patients with
CLD who are most likely to benefit from bone densitometry screening
based on clinical and biochemical measures.
Cross-sectional medical survey.
with CLD who were treated with either oral, inhaled, or no
glucocorticoid therapy. A control group without lung disease was
recruited from the same clinic population.
Measurements: Dual-energy X-ray absorptiometry was obtained
for each group, and the association between bone mass and clinical
variables, glucocorticoid use, gonadal hormones, and biochemical
markers of bone metabolism was determined.
Osteoporosis (a T score < −2.5 at the hip or spine) was five times
as likely in patients with CLD as in control subjects. Although the
prevalence of osteoporosis was higher (ninefold) after chronic
glucocorticoid therapy, patients with CLD who had never been treated
with glucocorticoids had a substantial (fourfold) risk of osteoporosis.
Chronic inhaled glucocorticoid therapy offered no protection from bone
loss compared to treatment with oral glucocorticoids. Of the clinical
and biochemical measures that were obtained, bone mass was weakly
correlated with body mass index (BMI), serum estradiol-17β, and
N-telopeptide, but not with testosterone, alkaline phosphatase,
bone-specific alkaline phosphatase, or osteocalcin.
Conclusion: Patients with CLD should be considered for bone
densitometry screening regardless of glucocorticoid use. Those patients
with a low BMI and/or decreased serum estradiol-17β comprise a
subgroup with increased risk for osteoporosis.