Very little is known about the possible osteopenic effect of intermittent courses of oral prednisone. This prospective study sought to compare the bone density in patients taking chronic oral steroids (OS), intermittent oral steroids (IOS) or inhaled steroids alone (IS).
Computerized pharmacy records were used to identify patients in a military medical center pulmonary clinic who were prescribed oral or inhaled steroids. 100 patients with obstructive lung disease participated in the study with a telephone survey, review of their computerized patient record and dual energy X-ray absorptiometry of the vertebral spine and proximal femur. Patients were divided up into 14 OS, 48 IOS and 38 IS. The T and Z scores were compared between groups and the effect of various confounding factors such as age, sex, menopause, exercise, calcium supplementation and steroid dose were evaluated.
No significant difference was noted in any of the descriptive factors. The average femur T score was -2.043 for OS, -1.402 for IOS and -1.168 for IS (difference significant only for OS vs IS, p< 0.0244). The average lumbar T score was -1.421 for OS, -1.217 for IOS and -0.410 for IS (difference significant for IOS vs IS and OS vs IS, p< 0.0108 and p<0.0259 respectively). The average femur Z score was -1.193 for OS, -0.444 for IOS and -0.646 for IS (difference significant only for OS vs IOS, p< 0.0117). The average lumbar Z score was -1.229 for OS, -0.404 for IOS and -0.053 for IS (difference significant only for OS vs IS, p< 0.0098). 33% of OS, 23% of IOS and 15% of IOS patients met WHO criteria for Osteoporosis based on a T score of -2.5 or less.
Osteopenia and osteoporosis trended to be greater in IOS patients compared with IS patients but not as severe as in OS patients, suggesting a clinically significant osteopenic effect from intermittent oral steroids.
Patients taking intermittent oral steroids should be screened for osteoporosis.
Bernard Roth, Grant monies (from industry related sources) This study was partially funded by a grant from the Geneva Foundation.