More Vigilance Needed to Prevent Osteoporosis in COPD Patients

For patients with asthma and chronic obstructive pulmonary disease (COPD) receiving therapies that pose a risk for osteoporosis, particularly corticosteroids, screening may help prevent irreversible bone loss, according to researchers gathered at the World Allergy Organization 2010 International Scientific Conference.

Dennis Ledford, MD, with Tampa, Fla.’s University of South Florida College of Medicine, James A. Haley Veterans Hospital and All Children's Hospital, notes that while the literature regarding the degree of risk for osteoporosis is inconclusive, prevention is nonetheless key.

"Once the damage is done, it is difficult to reverse. Therapies prevent bone loss more than they replace bone, so waiting for a problem to occur is ill-advised," Ledford said.

With osteoporosis becoming more common in the aging population, the risk associated with asthma and COPD treatments are something to consider, especially with the increased risk of mortality and morbidity associated with osteoporosis.

"The real risk is in fractures, and evidence suggests effects on bone density [with inhaled corticosteroids (ICS) treatment]. I would suggest that we be cautious," Ledford pointed out.

Other risk factors of osteoporosis include being female, since women have a lower body mass and estrogen levels drop in menopause, facilitating bone loss, as well as being Asian or Caucasian. Further, because lack of weight-bearing also contributes to the problem, and asthmatics tend to be less active than others, they have an increased risk of osteoporosis regardless of treatment currently underway.

To better screen for osteoporosis, Dr. Ledford recommends clinicians use the T score on bone scans. This score compares a patient’s bone density with that of a 25-year old. As the T score decreases by 1, the fracture rate doubles.

Further, he believes that patients requiring corticosteroids should seek treatment with ICS rather than systemic corticosteroids. This is because ISCs are safer than systemic corticosteroids because they differ in their effects on the bone. However, the safest option is still unknown.

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