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Study Suggests Chronic Lung Disease a Risk Factor for Osteoporosis

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Dec. 17, 1999 (New York) -- Chronic lung disease patients on long-term corticosteroids have long been considered a high-risk group for osteoporosis, largely because of their steroid use, which is believed to negatively impact bone density. However, new research suggests that having chronic lung disease alone, even in men who have never taken steroids, places them at elevated risk for osteoporosis. Chronic lung diseases in this study were defined as emphysema and bronchiectasis.

Mark Nanes, MD, PhD, the senior author of the study, tells WebMD, "We wanted to determine the disease burden among patients with chronic lung disease not on glucosteroids. ... Medicare won't pay for bone density tests unless individuals are taking glucosteroids." Nanes is chief of endocrinology at the Veterans Affairs Hospital and associate professor of medicine at Emory University in Atlanta.

In the survey, researchers compared four groups of men. Three groups had chronic pulmonary disease: those who took oral corticosteroids, those on inhaled corticosteroids, and those who had never taken steroids. Each group was compared with a control group who did not have chronic lung disease nor had they been ever treated with steroids. The analysis was based on a survey of 171 patients between the ages of 23 and 90 recruited from the Atlanta VA's outpatient clinics

"Men with chronic pulmonary disease were more than five times as likely to meet the World Health Organization's criteria for osteoporosis," says Nanes. "We also found no difference in risk between the two steroid-treated groups," but the study revealed that men treated with either type of steroid had a ninefold greater risk for osteoporosis [than the control group]."

Nanes says, "the study is important for those people who dole out the money." Based on the results, he says bone density screening should be used in this newly identified high-risk group. Fosamax (alendronate), a medication that reduces the amount of calcium lost in bones, is currently approved to treat osteoporosis, he says.

In an interview seeking objective review of the paper, Daniel Spratt, MD, tells WebMD that the investigators "did a good job of taking an initial look" at this population. The study gives "good preliminary information to suggest that pulmonary disease is a risk factor for osteoporosis, but that is not equivalent to backing screening [of the at-risk population]." Spratt is director of reproductive endocrinology at Maine Medical Center in Portland.

Although Spratt views the fivefold and ninefold difference as intriguing, he says, "it depends on how many people they mean." The study does not make that clear, Spratt says.

Another limitation is that the study is so small, says Spratt. "You need a much bigger study ... before you could conclude that screening is recommended. ... This may be the initial study that raises the question." Moreover, Spratt points out that there is almost no data on male osteoporosis.

Vital Information:

  • Chronic lung disease patients who take corticosteroids are known to be at high risk for osteoporosis.
  • A new study on men shows that men with chronic lung disease, even if they have never taken corticosteroids, are at high risk of developing osteoporosis.
  • Researchers say that all men with chronic lung disease should be screened, but another expert says the association should be studied further in larger populations.

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