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Original Research: COPD |

Prevalence and Progression of Osteoporosis in Patients With COPD: Results From the Towards a Revolution in COPD Health Study

Gary T. Ferguson, MD, FCCP; Peter M. A. Calverley, MD; Julie A. Anderson, MA; Christine R. Jenkins, MD; Paul W. Jones, MD; Lisa R. Willits, MSc; Julie C. Yates, BS; Jørgen Vestbo, MD; Bartolome Celli, MD, FCCP
Author and Funding Information

Affiliations: From the Pulmonary Research Institute of Southeast Michigan (Dr. Ferguson), Livonia, MI; the Department of Medicine (Dr. Calverley), University Hospital Aintree, Liverpool, UK; the Respiratory Medicines Centre (Ms. Anderson and Ms. Willits), GlaxoSmithKline, Middlesex, UK; Woolcock Institute of Medical Research (Dr. Jenkins), Camperdown, NSW, Australia; the Division of Cardiac and Vascular Science (Dr. Jones), St. George's, University of London, London, UK; the Respiratory Medicines Centre (Ms. Yates), GlaxoSmithKline, Triangle Park, NC; the Department of Cardiology and Respiratory Medicine (Dr. Vestbo), Hvidovre Hospital, Hvidovre, Denmark; the North West Lung Centre (Dr. Vestbo), Wythenshawe Hospital, Manchester, UK; and the Pulmonary and Critical Care Division (Dr. Celli), Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA.

Correspondence to: Gary T. Ferguson, MD, FCCP, Pulmonary Research Institute of Southeast Michigan, 28815 Eight Mile Rd, Suite 103, Livonia, MI 48152; e-mail: garytferguson@msn.com


For editorial comment see page 1448

Funding/Support: Supported by GlaxoSmithKline grant No. SCO30003.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1456-1465. doi:10.1378/chest.08-3016
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Background:  Osteoporosis is common in patients with COPD, but its prevalence and progression are not well characterized. Concerns have been raised over the possible deleterious effect of long-term therapy with inhaled corticosteroids (ICSs) on bone density in this population. Here, we investigated the long-term effects of therapy with fluticasone propionate (FP) alone, salmeterol (SAL) alone, and a SAL/FP combination (SFC) on bone mineral density (BMD) and bone fractures in patients with moderate-to-severe COPD in the TOwards a Revolution in COPD Health (TORCH) study.

Methods:  A randomized, double-blind, parallel-group, placebo-controlled study conducted at 88 US centers involving 658 patients (a subset of 6,184 international subjects in TORCH). Therapy with placebo, SAL (50 μg), FP (500 μg), or SFC (SAL 50 μg/FP 500 μg) twice daily was administered for 3 years. Baseline and yearly measurements of BMD at the hip and lumbar spine were performed. The incidence of traumatic and nontraumatic bone fractures was recorded.

Results:  At baseline, 18% of men and 30% of women had osteoporosis, and 42% of men and 41% of women had osteopenia based on BMD assessments. Forty-three percent of subjects completed all testing. The changes in BMD at the hip and lumbar spine over 3 years were small. No significant differences were observed between treatment arms (adjusted mean percent change from baseline at hip was −3.1% for placebo, −1.7% for SAL, −2.9% for FP, and −3.2% for SFC therapy, respectively; while, the corresponding changes for the lumbar spine were 0, 1.5%, −0.3%, and −0.3% for placebo, respectively, SAL, FP, and SFC therapy). The incidence of fractures was low and was similar for all treatments (5.1% to 6.3%).

Conclusions:  Osteoporosis is highly prevalent in patients with COPD, irrespective of gender. In the TORCH study, no significant effect on BMD was detected for ICS therapy compared with placebo.

Trial registration:  ClinicalTrials.gov Identifier: NTC00268216

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