Inhaled corticosteroids and bronchodilators have become a key element in the maintenance treatment of bronchial asthma and chronic obstructive pulmanory disease (COPD). It is well known that long-term systemic steroid use causes osteoporosis, whereas inhaled corticosteroids and bronchodilators have been discussed to be cause of such side-affect. The aim of this study was to detect the effect of long term inhaled/oral steroids and bronchodilators on bone mineral density (BMD) with asthma and COPD. Fifty-three patients with bronchial asthma (n=44) and COPD (n=9) were enrolled in this study. BMD were measured and risk factors for osteoporosis were detected. BMD measurements of lumbar area of the spine (L2-4), neck of femur and femoral ward’s triangle zone were performed by the dual energy x-ray absorptiometer (LUNAR). 53 patients evaluated in three groups according to treatment type; 26 patients were using inhaled corticosteroids and bronchodilators (group 1), 18 patients were using only bronchodilators (group 2) and 9 patients were using (group 3) oral corticosteroids and bronchodilators. There were significant differences between group 3 and other two groups in terms of BMD, T and Z scores of the lumbar and femoral neck (p 0.05). No difference in BMD, T and Z scores was noted between group 1 and group 2 (p0.05). As a result, we suggest that systemic corticosteroids negatively affect bone mineral density more than inhaled corticosteroids in patients with COPD. Key words: Bronchial asthma, bone loss, bone mineral density, chronic obstructive pulmonary disease (COPD), glucocorticoids induced osteoporosis, osteoporosis
Article in Turkish(Use the link for full-text in Turkish)
GIRIS
Osteoporoz azalmis kemik mineral yogunlugu ile birlikte mikromimaride yapisal degisikliklerin olustugu ve kirik riskinin arttigi metabolik bir kemik hastaligidir (1). Ilaçlara bagli olarak gelisen osteoporoz, en sik steroidler nedeniyle olusmaktadir (2). Bronsial astim ve kronik obstrüktif akciger hastaligi (KOAH) hava yollarinin kronik inflamatuar hastaliklaridir. Özellikle bu hastaliklarin ataklari sirasinda sistemik glukokortikoidlere basvurulmaktadir. KOAH’i olan hastalarin yaklasik % 36-60’inda osteoporoz gelismekte olup bu da hastaligin kendisi ve tedavisinde kullanilan glukokortikoidlerin etkisiyle olmaktadir (3). Epidemiyolojik verilerden elde edilen sonuçlar arasinda farkliliklar olmakla birlikte, 7,5-10 mg/gün prednizon’a esdeger dozun bir yildan uzun süreli kullaniminda % 30-50 oraninda kemik kaybina bagli kirik riski bildirilmektedir. Vertebra ve kalça kemikleri osteoporotik kiriklarin en sik görüldügü alanlar olup, bu bölgelerde ayni zamanda trabeküler kemik kaybi belirgindir (4). Sistemik steroidlerin yani sira inhale steroidler ve bronkodilatatörler, bronsial astim ve KOAH tedavisinde sikça kullanilan ilaçlardir. Bu ilaçlar hastaliklarin kontrolünde etkin olup, tedavi edici ajanlar degildir. Bu nedenle uzun dönem, kimi zaman ömür boyu ve yüksek dozlarda kullanimlari gerekmektedir (5,6). Son yillarda yapilan çalismalarda inhale steroidlerin oral steroidler gibi kemik üzerine olumsuz yönde etkilerinin olup olmadigi halen arastirilmaktadir (7). Bu çalismada astim veya KOAH’i olan hastalarda inhale ve sistemik steroid ile bronkodilatatör kullaniminin kemik mineral yogunlugu (KMY) üzerine etkisini arastirmak amaçlandi.
